Search

Introduction Rapid on-site evaluation (ROSE) is a technique used for immediate interpretation of transbronchial aspirates; there is debate as regards the contribution of ROSE to the diagnostic or staging process in patients with lung cancer undergoing endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). Aim of the study The aim of this study was to evaluate the role of ROSE during EBUS-guided TBNA in the diagnosis of the nature of mediastinal/hilar lesions detected using thoracic computed tomography regardless of whether or not there is a known lung malignancy. Patients and methods All patients with hilar/mediastinal lymph nodes having short axis of at least 1 cmon new thoracic computed tomography scan were included. The target lymph node was examined using real-time EBUS B-mode, and then TBNA was performed by inserting a dedicated 22-G needle through the working channel of the bronchoscopy. The samples were examined using the ROSE technique and then compared with the results of the final pathologic diagnosis. Results The current study was conducted on 47 patients (29 male and 18 female) with a age (mean±SD) of 56±15.4 years. EBUS-TBNA was performed for 129 mediastinal lesions in different stations. Among them, 77 of them were diagnosed as malignant initially on performing ROSE. After final histopathological and immunological examination, 74 lesions were proved to be malignant, whereas three lesions turned out to be benign. 52 lesions were diagnosed as benign on ROSE, whereas four of them were proved to be malignant on the final diagnosis, giving ROSE a specificity of 94.12%, sensitivity of 94.87%, and diagnostic accuracy of 94.57%. Conclusion ROSE has add-on advantages to EBUS-TBNA in many aspects, increasing diagnostic accuracy of EBUS-TBNA, increasing safety, and providing sufficient samples for subsequent immunocytochemical and molecular analysis.

Urban building disposition plays an important role in determining local microclimate including air quality. Ancient cities normally have some special building dispositions to reduce the penetration of cold wind in winter, which, however, may impact adversely on air pollutant dilution today. This paper investigated the pedestrian-level air quality at a common building disposition in Chinese ancient cities, namely a U-type street canyon. On-site measurements were conducted comparatively at a U-type street canyon and a nearby open space in Xi'an China during January 2015. Three primary air pollutants (PM10, PM2.5 and NO2) as well as wind speed and direction, air temperature and relative humidity were measured continuously from 8:00 a.m. to 8:00 p.m. for a six-day period that covered both clean and hazy days. Pedestrian-level wind condition at the U-type street canyon is mostly independent of that above the canyon, where adverse dilution condition is clearly evident for pollutants. PM2.5/PM10 ratio at the street canyon reached up to 0.9, which is nearly twice that at the nearby observatory. Overall, air quality index (AQI) in the street canyon is, on average, higher by 20% than that at the open space. These findings suggest that this ancient design should be discouraged.

Background: The diagnostic yield of peripheral pulmonary lesions (PPLs) by flexible bronchoscopy (FB) is still insufficient. To improve the diagnostic yield of bronchoscopy, several techniques such as endobronchial ultrasound (EBUS), virtual bronchoscopic navigation (VBN), and rapid on-site evaluation (ROSE) have been examined. The primary purpose of the present study was to evaluate the usefulness of combining EBUS, VBN, and ROSE for diagnosing small PPLs. Methods: Patients with PPLs 30 mm or less on chest computed tomography (CT) were prospectively enrolled. We determined the responsible bronchus for the target lesions using VBN before bronchoscopy was performed. EBUS and ROSE were performed during the examination to determine whether the bronchus and specimen were adequate. On the basis of previous studies, we assumed that the diagnostic yield of 85% among eligible patients would indicate potential usefulness, whereas, the diagnostic yield of 75% would indicate the lower limit of interest. The required number of patients was estimated as 45 for a one-sided α value of 0.2 and a β value of 0.8. The primary study endpoint was the diagnostic yield. Results: Between June 2014 and July 2015, we enrolled 50 patients in the present study, and we excluded 5 patients. The total diagnostic yield of 45 PPLs was 77.7%. In cases of lung cancer, the diagnostic yield was 84.2%. The sensitivity, specificity, positive predictive value, and negative predictive value of ROSE were 90.6%, 92.3%, 96.7%, and 80.0%, respectively. The diagnostic yield of PPLs from 20 to 30 mm was 87.5%, and the diagnostic yield of PPLs less than 20 mm was 66.7%. PPLs for which the probe was located within the lesion had the highest diagnostic yield. Conclusions: We could not demonstrate usefulness for diagnosing small PPLs by combining EBUS, VBN, and ROSE. However, combining these techniques may be useful for diagnosing lung cancer.

Context.— Endobronchial ultrasound–guided transbronchial needle aspiration (EBUS-TBNA) has emerged as a very useful tool in the field of diagnostic respiratory cytology. Rapid on-site evaluation (ROSE) of EBUS-TBNA not only has the potential to improve diagnostic yield of the procedure but also to triage samples for predictive molecular testing to guide personalized treatments for lung cancer. Objective.— To provide an overview of the current status of the literature regarding ROSE of EBUS-TBNA in the diagnosis of lung cancer. Data Sources.— An electronic literature search in PubMed and Google databases was performed using the following key words: cytology, lung cancer, on-site evaluation, rapid on-site evaluation, and ROSE EBUS-TBNA. Only articles published in English were included in this review. Conclusions.— Rapid on-site evaluation can ensure that the targeted lesion is being sampled and can enable appropriate specimen triage. If available, it should be used with EBUS-TBNA in the diagnosis of lung cancer because it can minimize repeat procedures for additional desired testing (ie, molecular studies). Some studies have shown that ROSE does not adversely affect the number of aspirations, total procedure time of EBUS-TBNA, or the rate of postprocedure complications; it is also helpful in providing a preliminary diagnosis that can reduce the number of additional invasive procedures, such as mediastinoscopy. As EBUS technology continues to evolve, our knowledge of the role of ROSE in EBUS-TBNA for the diagnosis of lung cancer will also continue to grow and evolve.

Background/aims Endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) has been used to diagnose gastrointestinal submucosal tumors (SMTs). Although rapid on-site evaluation (ROSE) has been reported to improve the diagnostic accuracy of EUS-FNA for pancreatic lesions, on-site cytopathologists are not routinely available. Given this background, the usefulness of ROSE by endosonographers themselves for pancreatic tumors has also been reported. However, ROSE by endosonographers for diagnosis of SMT has not been reported. The aim of this study was to evaluate the diagnostic accuracy of EUS-FNA with ROSE by endosonographers for SMT, focusing on diagnosis of gastrointestinal stromal tumor (GIST), compared with that of EUS-FNA alone. Methods Twenty-two consecutive patients who underwent EUS-FNA with ROSE by endosonographers for SMT followed by surgical resection were identified. Ten historical control subjects who underwent EUS-FNA without ROSE were used for comparison. Results The overall diagnostic accuracy for SMT was significantly higher in cases with than without ROSE (100% vs. 80%, p=0.03). The number of needle passes by FNA with ROSE by endosonographers tended to be fewer, although accuracy was increased (3.3±1.3 vs. 5.9±3.8, p=0.06). Conclusions ROSE by endosonographers during EUS-FNA for SMT is useful for definitive diagnosis, particularly for GIST.

Rapid on-site evaluation (ROSE) is one of cytopathology’s “unique selling propositions.” The quality, speed, and ease of handling of the staining used is a critical factor for the efficacy of the ROSE procedure. Here, we describe a modification of rapid toluidine blue staining that can be performed within 25 s, provides excellent nuclear morphology, and is compatible with subsequent Papanicolaou staining of the slides. Furthermore, exposure to hazardous chemicals is minimized, as no organic solvents other than the alcohol-based fixative and glycerin for temporary mounting and coverslipping are required. We have used this protocol successfully in our ROSE practice and have not observed any discrepancies between toluidine blue- and permanent Papanicolaou-stained slides.

Objectives We evaluated telecytology rapid on-site evaluation (ROSE) for thyroid ultrasound-guided fine-needle aspiration. To the best of our knowledge, this study is the first case-control clinical trial of thyroid telecytology. Methods We introduced on-site ROSE in our institution’s thyroid clinic for 6 months, followed by telecytology for 12 months. Our institution’s ultrasound clinic, where ROSE is not provided, was used as a control group for each period. Results Both groups had similar initial unsatisfactory rates (thyroid clinic: 8.8%; ultrasound clinic: 8.0%) before the study began. The thyroid clinic’s unsatisfactory rate was significantly reduced to 1.6% after on-site ROSE (P = .001) and to 3.8% after telecytology ROSE (P = .010), with no significant difference between on-site and telecytology ROSE periods (P > .05). The ultrasound clinic’s unsatisfactory rate was unchanged for both periods. Concordance between telecytology ROSE and final adequacy was 97% (κ = 0.699). Conclusions Telecytology ROSE reduces unsatisfactory rates for ultrasound-guided fine-needle aspiration without compromising patient care.

Background and Aims: Rapid on-site evaluation (ROSE) of cytologic samples obtained during bronchoscopy was long used to improve diagnostic rates. However, its value in the prompt preliminary diagnosis of pulmonary infection has not been established. We performed ROSE with fast staining methods during bronchoscopy in order for rapid infection diagnosis. Materials and Methods: We prospectively studied 35 patients with suspected lung infections who underwent bronchoscopy in 2018. ROSE was performed during bronchoscopic examinations. Several slides were smeared, of which the first stained with Diff-Quick staining (fig.1). The second was performed the fluorescent staining specially for fast-acid bacteria if mycobacterium infection was suspected. An immune-fluorescent staining was either performed if fungal infections were suggested (fig.2 ). The last samples were submitted for laboratory studies Results: 29 samples were suspected as infectious on site and sent for laboratory studies. All samples with lung infection diagnosed by ROSE had a concomitant sample submitted for pathological test and microbe culture and 10% for NGS. Of these cases, 86% had growth on culture and/or had a positive laboratory study. Among cases in which lung infections were diagnosed and laboratory studies were positive, the accuracy of ROSE identification was 95%. Conclusions: ROSE can aid bronchoscopists by confirming best biopsy sites and obtain sufficient tissue for diagnosis and ancillary testing. It’s feasible that ROSE with fast staining methods helpful of evaluating pulmonary infection during bronchoscopy rapidly on site.

Introduction: Endobronchial ultrasound (EBUS) / Endoscopic ultrasound (EUS) has become an essential investigation tool in lung malignancy. In our centre we use Rapid on-site evaluation (ROSE), which is performed by our Cytopathology team comprising a trained Biomedical Scientist and, a Cytopathologist, allows rapid assessment of adequacy, provisional diagnosis and appropriate triage of EBUS/EUS specimens. We have audited our data in our centre since the establishment of EBUS/EUS TBNA and ROSE. Methods and Results: We present here a cohort of patients with suspected lung malignancy who underwent EBUS /EUS TBNA and ROSE in our centre between from October 2013 to June 2018. A total of 295 aspirates sites from 249 patients with suspected lung malignancy were collected during this period. Mean number passes for diagnoses on ROSE was 1.4 and mean number of total nodal passes was 3.2. Mean number of nodal sites biopsied per patient was 1.18. In 253 aspirates, malignancy was confirmed as per initial ROSE assessment. 34 aspirates were suggestive of malignancy, 4 aspirates were equivocal and 4 were assessed as benign, and the final outcome of these aspirates were malignant on cell block. 26 of these patients had Next Generation Sequencing (NGS) of cytological samples and we had a success rate of 21 /26 ( 77%). 5 patient had repeat procedure for molecular analysis. Conclusion: EBUS/EUS with ROSE is effective in achieving diagnoses with fewer needle passes and reduces inadequate rate and therefore the need for repeat procedures. The samples obtained with the aid of ROSE can be maximised so that the majority of the sample can be made into a cell block for further studies.

Objective To evaluate the applied value of rapid on-site evaluation during endobronchial ultrasound (EBUS) with a guide sheath for peripheral pulmonary lesions (PPLs). Methods Consecutive patients who underwent EBUS with a guide sheath for PPLs at our hospital from December 2015 to June 2017 in this retrospective study. The samples obtained from each operation were made rapid on-site evaluation at the same time. The results of rapid on-site evaluation were compared with the pathological diagnosis. Results A total of 127 PPLs in 124 patients were included in the study. 70 lesions were malignancy in the final pathological diagnosis. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of rapid on-site evaluation for malignancy during EBUS with a guide sheath for PPLs was 88.6%, 98.2%, 98.4%, 87.5% and 92.9%, respectively. Conclusions Rapid on-site evaluation during EBUS with a guide sheath has a high diagnostic value for malignant PPLs.

Evidence of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in extrathoracic malignancy is limited but emergent. The technique plays a vital role in the diagnosis of mediastinal lesions, staging, and restaging of lung cancer. Its usefulness for the evaluation and molecular classification of progressive breast cancer is described in 7 patients. Stations 7, 11L, and 11R were punctured. Cellblocks, immunohistochemistry and digital analysis were developed in 100% of the cases for molecular classification. This procedure requires multidisciplinary evaluation, image analysis, and evaluation of the general condition of the patient, as well as the risks and benefits. Additionally, it is essential teamwork with a pathology group that performs the rapid on-site evaluation (ROSE), in order to ensure the quality of the samples and molecular characterization. Resumen Evidencia de la aspiración transbronquial con aguja guiada por ultrasonido endobronquial en malignidad extratorácica es limitada pero emergente. Esta técnica desempeña un papel vital en el diagnóstico de lesiones mediastinales, estadificación y reestadificación del cáncer pulmonar. Se describe su utilidad para la evaluación y la clasificación molecular del cáncer de mama en progresión de siete pacientes. Se puncionaron las estaciones (ganglionares) 7, 11L y 11R. Se desarrollaron bloques celulares, inmunohistoquímica y análisis digital en el 100% de los casos para clasificación molecular. Este procedimiento requiere una evaluación multidisciplinaria, análisis de imágenes y la evaluación del estado general de la paciente, lo mismo que los riesgos y los beneficios. Adicionalmente, es esencial el trabajo conjunto con un grupo de patología que realice la evaluación rápida en sala (ROSE), para así asegurar la calidad de las muestras y la caracterización molecular.

Limited methods for colistin MIC determination are available to clinical microbiology laboratories. The purpose of this study was to evaluate the accuracy of the colistin broth disk elution (CBDE) test compared to that of broth microdilution (BMD) for identifying colistin MICs. CBDE was compared to colistin BMD using a collection of Gram-negative bacilli tested at two U.S. microbiology laboratories. The isolates tested included 121 retrospective clinical isolates, 45 prospective clinical isolates, and 6 mcr-1-positive Escherichia coli isolates. CBDE was performed with four 10-ml cation-adjusted Mueller-Hinton broth tubes per isolate, to which 0, 1, 2, and 4 colistin 10-µg disks were added, generating final concentrations in the tubes of 0 (growth control), 1, 2, and 4 µg/ml, respectively. MICs were evaluated visually and interpreted using Clinical and Laboratory Standards Institute breakpoints. Site 2 also compared CBDE to the reference broth macrodilution (BMAD) method (n = 110 isolates). Overall, CBDE yielded a categorical agreement (CA) and essential agreement (EA) of 98% and 99%, respectively, compared to the results of colistin BMD. Very major errors occurred for mcr-1-producing strains, with MICs fluctuating from 2 to 4 µg/ml on repeat testing. The results for all other isolates were in CA with those of BMD. CBDE versus BMAD had an EA of 100% and a CA of 100%. Compared to currently used techniques, CBDE is an easy and practical method to perform colistin MIC testing. Some mcr-1-producing isolates yielded MICs of 2 µg/ml by CBDE and 4 µg/ml by BMD. As such, the results for isolates with colistin MICs of 2 µg/ml by CBDE should be confirmed by the reference BMD method, and isolates with MICs of ≥2 µg/ml should be evaluated for the presence of mcr genes.

Estimating the energy potential of tidal stream site is a key feature for tidal energy system deployment. This paper aims to compare two methods of prediction of tidal current velocities. The first one is based on the use of a fully three-dimensional (3D) numerical approach. However, while being accurate, the numerical model is highly time-consuming. The second method is based on a linear approximation of the tidal current, which only requires preliminary knowledge of local current velocities time series during two typical tidal cycles. This second method allows a very quick evaluation of the tidal stream resource during a long time period. The proposed comparison is done in three different locations of a high potential tidal energy site in west of France. It is carried out in terms of current velocity and energy harnessing for several turbines technology options (with and without yaw). The achieved results show that the linear approximation gives satisfactory evaluation of the tidal stream potential and can be a very interesting tool for preliminary site evaluation and first technology options selection. However, the fully 3D numerical model can obviously be very useful in more advanced steps of a project.

Implant site evaluation is a critical step in the treatment planning process. Adequate radiographs, study models, and evaluation of the bone and soft tissue are necessary to avoid peri-implant problems. Implant selection and spacing requirements are also reviewed.

In this study, we employed a geographic information system (GIS)-based approach to identify sites suitable for large-scale solar photovoltaic (PV) power plant installations in Mongolia. Accordingly, cells of 30 × 30 m were used, and data based on seven criteria, including annual global horizontal radiation, annual average temperature, elevation, slope, slope direction (aspect), and distances from main roads and major power lines, were collected for each cell. GIS layers for these seven criteria were then converted into rated value layers using four grades. The weightings applied to the seven criteria were determined, using an analytical hierarchy process, by ten solar field experts. By combining the seven rating value layers with the weightings, a site suitability map was developed, using good, fair, low, and poor suitability grades. The results showed that sites graded as good, fair, low, and poor accounted for 3.27%, 53.06%, 42.59%, and 1.08% of the total surface area, respectively. Good sites were predominantly located in the southern and central regions of Mongolia. As the current demand for electric power in southern and central regions is low and high, respectively, we concluded that the central region of Mongolia should be prioritized for installing PV power plants.

The high rate of urbanization is one of the problems that has occurred in Jakarta as capital of Indonesia. The implication is the change in land use from pervious cover to impervious cover which have an impact on increasing stormwater runoff. Jakarta International Expo (JIExpo) is one of commercial complex in Central Jakarta. The complex covered area around 43.59 hectares and highly impervious (approximately 84 percent). This study simulating two stormwater facilities green roofs and permeable pavements, with total area to be converted aproximately 9.21 hectares (21 percent). The modelling run using Site Evaluation Tools (SET) Microsoft Excels spreadsheet to show the both of stormwater facilities effect on the surface runoff and peak flow. The results indicated that the techniques can be used to reduce runoff volume and peak flow. Per unit area, the green roofs better than permeable pavements at reducing the surface runoff evaporation and evapotranspiration. However, permeable pavements were better than green roofs at increasing infiltration. The simulation shows that by the combination of green roofs and porous pavement, the surface runoff can reduced by approximately 57%, the runoff volume can reduced by approximately 1.20% for 2-year daily rainfall, and the peak flow can reduced by approximately 50%. Overall, the SET is easy to use and useful for evaluating the effects of stormwater facilities.

Road traffic crashes is one of the major causes of death that needs to be addressed globally. Many studies have been conducted to identify the contributing factors to traffic crashes and to determine the required preventive measures. This study evaluates the causes of 164 traffic crashes along a 10 kilometres section of Pan Borneo Highway Sarawak. The study investigated the main causes of traffic crashes within this section of road through multiple sources: based on expert on site evaluation, analysis of site incident report and police accident record. The finding reveals that most of the accidents (93%) occurs during the daytime, weather contributes a combined 69% and private car owners (80%) cause most of the traffic crashes. The study also indicates that the road condition is a significant factor to the occurrence of traffic crashes in that area contributing 64% of the total crashes.

Objectives To evaluate the value of rapid on-site evaluation (ROSE) during radial probe endobronchial ultrasound transbronchial lung biopsy (rpEBUS-TBLB) for peripheral pulmonary lesions (PPLs). Methods One hundred and six patients with PPLs who received rpEBUS-TBLB were enrolled in this study. One specimen was immediately examined by ROSE and the other was sent to the central laboratory for cytologic diagnosis. The results of ROSE were compared with those of pathological diagnosis. Results The diagnostic accuracy, sensitivity, and specificity of ROSE during rpEBUS-TBLB for PPLs were 82.1%, 89.6%, and 77.1%, respectively. The procedure times and number of biopsies were less for procedures when ROSE was positive compared with those when ROSE was negative (procedure time: 20.5 ± 7.9 vs. 28.3 ± 7.6 minutes; number of biopsies: 1.6 ± 0.9 vs. 2.8 ± 0.6 times). No serious procedural complications were observed. Conclusions ROSE has value for diagnosing PPLs during rpEBUS. It can reduce procedure time, number of biopsies, and complications. ROSE combined with rpEBUS is an effective and safe method for the diagnosis of PPLs.

This paper discusses a monitoring method of on-site evaluation of measurement standards. By means of data acquisition, image recognition, mobile Internet and big data analysis, it can collect real-time field image and sound information in the process of measurement on-site verification, and effectively identify the field collected information, calculating the difference value between the actual measurement and the standard value. On the one hand, according to the different categories, the field operators are warned and instructed by means of voice, image and other means. On the other hand, it records the key information of the measurement field verification, and assists the field operators to complete the online filing of engineering data, so as to realize the monitoring of measurement standard on-site evaluation process.

Rapid on-site evaluation (ROSE) with routine fine-needle aspiration cytology (FNAC) is a simple, economical, highly accurate tool in the diagnosis of tuberculous lesions. The sample collected can be used for ancillary studies, i.e., Ziehl–Neelsen stain, Cartridge-based nuclei acid amplification testing (CB-NAAT) and bacterial culture for confirmation of the tubercular species. We report a case of a 31-year-old male who presented with left supraclavicular lymphadenopathy. ROSE with FNAC helped in the diagnosis of the patient. FNAC is a rapid minimally invasive method for the early detection of tubercular lesions and helps in proper treatment.

Objective: The accuracy of rapid on-site evaluation (ROSE) during endobronchial ultrasonography with guide sheath (EBUS-GS) was reported to be approximately 90% for diagnosing small peripheral pulmonary lesions (PPLs). When ROSE during EBUS-GS for diagnosing small peripheral lung cancer is carried out and does not include malignant cells in a position whereby the probe was located within or adjacent to the lesion, the best technique for overcoming the lower diagnostic yield remains unknown. This study aimed to evaluate factors affecting positive results of ROSE during EBUS-GS in such a probe position. Moreover, when the results of ROSE were consistently negative, we evaluated the effectiveness of conventional transbronchial biopsy (TBB) in addition to EBUS-GS alone. Methods: We performed a retrospective analysis of consecutive patients who underwent EBUS-GS combined with ROSE for diagnosing small peripheral lung cancer (≤30 mm). We classified the results of ROSE into two groups based on the presence of malignant cells: the ROSE positive group (included malignant cells) and the ROSE negative group (did not include malignant cells). The significant predictors of positive ROSE results during EBUS-GS were analyzed using multivariate logistic regression analyses. Results: We identified 67 lesions (43 lesions in the ROSE positive group and 24 lesions in the ROSE negative group, respectively). Multivariate logistic analysis revealed that the significant factor affecting positive ROSE results was lesion size (>15 mm) (OR = 9.901). The diagnostic yield of additional conventional TBB to EBUS-GS was significantly higher than that of EBUS-GS alone (75.0% vs 33.3%, P = .041). Conclusion: The positive results of ROSE during EBUS-GS were significantly influenced by lesion size (>15 mm). When the results of ROSE during EBUS-GS were consistently negative in a position whereby the probe was located within or adjacent to the lesion, additional conventional TBB was effective to improve the diagnostic yield compared with EBUS-GS alone.