그람양성균 감염에 대한 Teicoplanin의 임상적 효과

최강현,송재훈,조구영,유빈,김형호,서철원,배직현 대한감염학회 1993 감염 Vol.25 No.1

Backgrounds: Gram-positive cocci have been an increasing cause of nosocomial infections in recent years. Treatment of these infections is often difficult, particularly infections by methicillin-resistant Staphylococcus aureus (MRSA). Teicoplanin, a new glycopeptide antibiotic, has been reported to have an excellent in vitro and in vivo effect against various gram-positive infections. To evaluate the clinical efficacy of teicoplanin in the treatment of patients with gram-positive bacterial infection and to compare the in vitro susceptibility of teicoplanin with other antimicrobials, we performed a prospective open trial of teicoplanin. Methods: Twenty patients with infections by gram-positive organism were enrolled. The patients were received 400mg of teicoplanin followed by 200 mg from next day as maintenance dose. During the follow-up period, clinical features and laboratory parameters were ckecked to evaluate clinical efficacy and appropriate cultures were followed to determine the microbiologic efficacy. The adverse effects of teicoplanin were also observed. Results: The enrolled patients were 16 males and 4 females, whose mean age was 51±13 years. The categories of infections were bacteremia (5), skin and soft tissue infection (4), empyema (3), UTI (2), pneumonia (1), catheter associated infection (1) and infective endocarditis (1). The etiologic organisms isolated were MRSA (9), coagulase-negative Staphlycoccus (5), S. viridans (2), group D streptococcus (2), S. pneumoniae (1), and E. faecalis (1). All 20 patients treated with teicoplanin showed clinical cure (13/20) or clinical improvement (7/20), whereas 90% of isolated organisms were eradicated after teicoplanin therapy. The adverse effect of teicoplanin was minimal. Conclusion: Teicoplanin is safe and effective in the therapy of many different infections caused by gram-positive oragnisms.

영도구의 생식보건사업 성과분석 : 남자중학생을 대상으로 한 성교육 효과 분석을 중심으로 the Effects of Sex Education on Middle School Students

남은우,강혜숙,박성빈,최재임,민체류 고신대학교 영도발전연구소 2001 영도연구 Vol.3 No.-

The purpose of this study was to reduce the sexual problems of middle school students in Youngco-Gu, Busan. The survey was conducted by content analysis which was related with reproductive healty services such as budget, manpower, etc. This study was also conducted with sex education as the object and to measure the effects of sex education. Questionnaires from 203 students(7th-9th graders) in a male middle school were surveyed on Sept. 12-14, 2001. The statistical analysis used were t-test, paired t-test, one-way ANOVA and χ^2 test by using SPSS/PC+ WIN 8.0 program. The results of this study are summarized as follows: First, 66.2% of the students among the subjects had a religion, and of those 50% were buddhists, 34.4% christians, 9.5% catholic. Religion of sexual related matters showed no significant effect. Of these students 68.1% showed medium interest in sexual related matters, 18% little interest or none and 13.5% high interest. 8th graders seemed to show more interest in sexual related matters than other grades. 41.8% of Students seemed to get information on sexual matters from friends and 27.1% from the internet. 30.9% of the respondents talked about their boy/girl friends with their parents compared to 43.3% who chose to talk to their friends about their sexual related problems. Second, 56.7% logged into lascivious-sites on the internet. Of those who logged onto lascivious-sites 46.1% logged in once or twice a month, 31.9% once or twice a week, and 2.7% logged in daily, 69.2% Felt curiosity, 23.4% felt indecent and 7.5% felt like engaging in a sexual act after visiting one of these sites. Third, the effects of sex education on experimental groups of 7th graders showed a 2.1 point increase(p<0.1), 4 point increase for 8th graders(p<.001), and 9th graders increased by 3.3 points(p<.001). Therefore this showed that it was advantageous for students to have sex education. Fourth, the effects of sex education on the students attitude showed only a little more improvement than before in the controlled groups whereas the experimental groups showed a large increase in good attitude in a good direction. Therefore, the experimental groups showed better results in sexual attitude compared to the controlled groups(p<.01).

인간 면역부전 바이러스(HIV) 감염자 사이에서의 1기 및 2기 매독의 유행

장희창,조재현,박완범,이기덕,이창섭,김홍빈,오명돈,최강원 대한감염학회 2004 감염과 화학요법 Vol.36 No.6

목적 : 국내 HIV 감염자 사이에서 발생한 매독의 유행을 보고하고, 그 역학적 특성을 규명하고자 하였다. 재료 및 방법 : 1999년 7월부터 2003년 9월까지 서울대학교 병원에서 추적 관찰을 받아온 HIV 감염자를 대상으로 하여 1기 및 2기 매독의 발생을 조사하였다. 발생률을 정확히 구하기 위해 추적 관찰을 받은 모든 HIV 감염자의 인년을 6개월 간격으로 구하였다. 결과 : 51개월 동안, 465명의 HIV 감염자가 서울대학교 병원에서 추적 관찰을 받았다. 이중 38명이 1기 및 2기 매독으로 진단되었다. 1기 및 2기 매독의 발생률은 이기간 동안 100인년 당 4.1명이었다. 1999년 7월부터 2001년 12월 사이에는 발생자가 없었으나, 이후 발생률은 꾸준히 증가하여 2003년 9월에는 100인년 당 18.8명이 되었다. 1기 및 2기 매독의 발생률은 동성애자 및 양성애자에서 이성애자에서보다 4.3배 높았고, HAART로 치료를 받지 않은 환자에서 HAART로 치료를 받고 있던 환자에서 보다 10.9배 높았다. 결론 : 2002년부터 국내 HIV 감염자 사이에서 1기 및 2기 매독이 유행하기 시작하였고, 이러한 유행은 동성애자와 양성애자 및 HAART로 치료를 받고 있지 않던 사람 사이에서 발생하였다. Background : This study was performed to characterize the epidemiologic and clinical features of outbreak of syphilis among HIV sero-positive patients in Korea. Materials and Methods : A retrospective case review of patients diagnosed with primary and secondary syphilis from July 1999 to September 2003 was carried out at Seoul National University Hospital in Korea. To estimate the incidence, person-years (PYs) of all HIV sero-positive patients, who visited the hospital in the same period, were calculated every 6 months. Results : In a 51 month period, 465 HIV-positive patients were followed up at Seoul National University Hospital. 38 cases of primary and secondary syphilis were diagnosed. The incidence of primary and secondary syphilis was 4.1 per 100 PYs during the study period. There was no case from July 1999 to December 2001, and then the incidence rose until September 2003 from 5.5 per 100 PYs in 1999 to 18.8 per 100 PYs in 2003. The rate of primary and secondary syphilis was 4.3 times higher among homosexual and bisexual men than heterosexual men (95% CI 1.87 to 11.17), and 10.9 times higher among patients who did not receive HAART than patients who were receiving HAART (95% CI 5.47 to 21.79). Conclusion : The outbreak of primary and secondary syphilis among HIV-positive patients started in 2002 and has been escalating, especially among homosexual/bisexual men and in patients who did not receive HAART.

국내 다기관에서 조사한 지역사회획득 메티실린내성 황색포도알균의 빈도와 임상적 특성

송진수,최평균,송경호,조재현,김성한,방지환,이창섭,박경화,박경운,신수,최희정,김의석,김동민,이미숙,박완범,김남중,오명돈,김의종,김홍빈,최강원 대한감염학회 2006 감염과 화학요법 Vol.38 No.6

목적 : 최근 전세계적으로 지역사회획득 메티실린내성 황색포도알균(community-associated methicillin-resistant Staphylococcus aureus, CA-MRSA)의 보고가 증가하고 있다. 하지만, 우리나라에서는 CA-MRSA 감염증에 대한 증례보고만 있을 뿐 아직까지 체계적인 연구결과가 없는 실정이다. 저자들은 국내에서 CA-MRSA의 빈도, 감염증의 임상적 양상, 분리된 균주의 항균제내성 양상을 조사하였다. 재료 및 방법 : 2005년 1월부터 2005년 6월까지 7개 병원에서 MRSA가 분리된 환자의 명단을 파악한 후 의무기록지와 건강보험심사평가원의 자료를 검토하였다. 외래나 응급실에서 혹은 입원 후 72시간 이내에 균주가 분리되고 MRSA 획득과 관련된 위험인자가 없는 경우 CA-MRSA로 정의하였으며, 분리된 균주의 임상적 의미에 따라 원인병원체(pathogen), 집락화(colonizer), 미결정(undetermined)으로 분류하였다. Penicillin과 oxacillin을 제외하고 3개 이상의 다른 계열 항균제에 내성이면 다제내성으로 정의하였다. 결과 : 연구기간동안 총 3,251주의 황색포도알균이 분리되었으며, 이 중 MRSA는 1,900주(58.4%)였다. MRSA 가운데 CA-MRSA는 114주(6.0%) 였으며, 이들이 분리된 부위는 귀(62주), 비뇨기계(14주), 피부 및 연부조직(11주), 호흡기계(10주), 혈액(3주) 등이었다. CA-MRSA 균주 가운데 집락균은 22주, 원인병원체는 22주였으며, 나머지 균주에 대해서는 그 임상적 의미를 결정할 수 없었다. 항균제 감수성 검사를 시행한 73균주 중 47주(64.4%)는 다제내성이었다. CA-MRSA 감염증 22예 중 피부 및 연부조직 감염(9예)과 중이염/외이도염(9예)이 가장 흔하였다. 침습적 감염증(invasive infection)은 4명(원발성 균혈증 3예, 감염성 관절염 1예)에서 확인되었지만, CA-MRSA 감염증으로 사망한 환자는 없었다. 결론 : 병원내 감염증에서는 MRSA가 심각한 문제이지만, 아직까지 지역사회 감염증에서 CA-MRSA는 흔하지 않았다. Background : Methicillin-resistant Staphylococcus aureus (MRSA) infection has emerged in patients who do not have the established risk factors. In Korea, little is known about the epidemiology and clinical features of community-associated MRSA (CA-MRSA). Material and Methods : Clinical microbiology laboratory databases of 7 hospitals were reviewed to identify the patients from whom MRSA was isolated during the period of January to July 2005. Only one isolate per patient was enrolled. In order to identify the risk factors of MRSA acquisition, the medical records and the Health Insurance Review Agency databases were reviewed. CA-MRSA was defined as MRSA isolated from patient without established risk factors. We analyzed patient demographics, underlying medical conditions, characteristics of infection, and antimicrobial susceptibility profiles. Results : Of total 3,251 S. aureus isolates, 1900 (58.4%) were MRSAs. Of the MRSA isolates, 114 (6.0%) were CA-MRSA. Of 114 CA-MRSA isolates, 22 (19.3%) were colonizers, 22 (19.3%) were pathogens, and the clinical significance of remaining 70 (61.4%) could not be determined. Median age of the 22 patients with CA-MRSA disease was 47 years. Nine patients had skin and soft tissue infections, 9 ear infections, 3 bacteremia, 1 septic arthritis. Seven patients had underlying medical disease. None died of the CA-MRSA infections. Of the 73 isolates of CA-MRSA, 47 (64.4%) were resistant to more than 3 classes of antibiotics besides β-lactams. Conclusion : Although MRSA is highly prevalent among hospital-associated S. aureus infection, CA-MRSA infections are not common.

국내 의료기관의 항생제 사용 실태와 규제 시스템 조사

방지환,송경호,박완범,김성한,조재현,김홍빈,김남중,오명돈,최강원 대한감염학회 2006 감염과 화학요법 Vol.38 No.6

목적 : 이전 연구들에 따르면 아직까지 국내에서 불필요한 항생제 사용은 무시할 수 없는 수준이며, 특히, 수술환자들에 대한 예방적 항생제 투여가 문제로 지적되고 있다. 많은 병원에서 불필요한 항생제 처방을 제한하려는 노력을 하고 있지만 구체적인 현황에 대한 자료는 적은 실정이다. 이에 본 연구자 등은 국내 의료기관의 항생제 규제 시스템의 현황과 수술시 예방적 항생제 사용의 적정성을 알아보고자 한다. 재료 및 방법 : 전임 감염내과 전문의가 근무하는 의료기관 55곳에 대해 설문조사를 시행하였다. 설문의 내용은 적정한 항생제 사용을 유도하기 위한 정책 및 규제 프로그램, 실제 각 의료기관의 예방적 항생제 사용 현황 등으로 이루어져 있다. 결과 : 55개의 의료기관에 보낸 설문 중 44개가 회수되었다. 회신한 의료기관에서 항생제 처방 관리는 제한항생제 시스템을 가장 많이 이용하고 있었고(95.5%), 항생제에 대한 교육(79.5%), 전산시스템에서 관리(59.1%), 감염내과에 의뢰(54.5%), 항생제 사용 실적 검토(52.3%) 등의 순이었다. 대개의 병원에서 glycopeptides (100.0%), carbapenems (93.0%), quinupristin/dalfopristin 또는 linezolid(93.0%), 4세대 cephalosporin (74.4%), caspofungin 또는 voriconazole (62.8%), liposomal amphotericin B (60.5%) 등을 제한항생제로 분류하여 관리하고 있었다. 모든 의료기관에서 위절제술 및 유방절제술시에 불필요하게 예방적 항생제를 사용하고 있었다. 슬관절치환술의 경우 2세대 cephalosporin을 예방적으로 사용하는 경우가 가장 많았으며(30.2%), 관상동맥우회술의 경우 3세대 cephalosporin을 예방적으로 사용하는 경우가 가장 많았다(47.2%). 예방적 항생제의 투여 기간을 살펴보면 위절제술시 70.5%에서 4일을 초과하여 사용하고 있었고, 유방절제술시에는 63.6%에서, 슬관절치환술시에는 81.8%에서, 관동맥우회술시에는 81.1%에서 4일을 초과하여 장기간 예방적 항생제를 투여하고 있었다. 한편, 예방적 항생제 투여시 aminoglycoside계 항생제를 병용하는 경우도 많았다. 결론 : 아직까지 국내 의료기관에서 항생제 오남용을 막기 위한 노력이 더 필요할 것으로 생각되며, 특히 수술시 예방적 항생제의 올바른 투여에 많은 관심이 필요하다. Background : Previous studies in Korea showed that unnecessary antibiotic use could not be neglected, especially in prophylactic use. Currently many hospitals employ diverse antibiotic stewardship programs, but there are few studies on surveillance of such programs. So, we planned this study to evaluate current status of antimicrobial stewardship and adequacy of antimicrobial prophylaxis in surgery. Materials and Methods : We sent questionnaires about policy on antibiotic usage, control program for adequate antibiotic prescription, and actual status of prophylactic antibiotic usage to 55 infectious disease physicians in each hospital. Results : Of 55 contacted infectious diseases clinicians, 44 answered the questionnaire. Majority of hospitals employed restricted antimicrobial system (95.5%), education (79.5%), control by order communicating system (59.1%), consult to infectious disease physicians (59.1%), and review of cumulative antimicrobial usage (52.3%) to prevent inadequate antibiotic use. Glycopeptides were designated as a restricted antimicrobial agent in 100.0% of hospitals; carbapenems, 93.0%; quinupristin/ dalfopristin or linezolid, 93.0%; the 4th generation cephalosporins, 74.4%; caspofungin or voriconazole, 62.8%; liposomal amphotericin B, 60.5%, and so on. Unnecessary perioperative prophylactic antimicrobial agents were prescribed in gastrectomy and mastectomy in all the hospitals. The second generation cephalosporins and the third generation cephalosporins were the most commonly prescribed prophylactic antimicrobial agents in total knee replacement arthroplasty (TKRA) and coronary artery bypass graft surgery (CABG) respectively. In 70.5% of institutes they use prophylactic antimicrobial agents more than four days in gastrectomy; 63.6% in mastectomy; 81.8% in TKRA; 81.1% in CABG. Unnecessary combination of aminoglycosides with other antimicrobial agents for prophylactic use was another common problem. Conclusion : This study shows that more effort is required to diminish antimicrobial misuse or overuse, especially in prophylactic use for surgical patients.

골수구성 백혈병 환자에게 발생한 결핵성 림프절염

이창섭,송진수,최평균,조재현,방지환,박경화,박완범,김홍빈,김남중,윤성수,박선양,김병국,오명돈,최강원 대한감염학회 2006 감염과 화학요법 Vol.38 No.5

혈액질환 가운데 결핵 발생이 증가한다고 알려진 것은 호지킨 림프종을 포함한 림프증식성질환 그리고 모양세포성 백혈병 등이 있다. 또한 동종 골수이식을 받은 환자에서도 결핵은 증가한다고 알려져있다. Kaplan 등은 골수구성 백혈병 환자에서 결핵 발생이 증가한다고 보고하였다. 그러나 골수구성 백혈병 환자에서 결핵의 발생이 증가하는 이유에 대해서는 아직까지 정확하게 밝혀지지 않았다. 저자들이 2년 동안 후향적으로 조사한 180명의 성인 골수구성 백혈병 환자들 가운데 결핵이 발생한 환자는 4명이었고, 발생 부위는 모두 림프절이었다. 결핵은 골수구성 백혈병의 특정 아형에만 국한되어 발생하지 않았지만, 50%에서 FAB 분류에 의한 M4였다. 림프절이 종대된 골수구성 백혈병 환자에서 특히, 결핵의 유병율이 높은 나라에서는 결핵성 림프절염도 감별진단에 포함시켜야 한다. During the neutropenic phase, leukemia patients receiving chemotherapy are prone to bacterial and, fungal infections; occasionally mycobacterial, viral and protozoal organisms may also cause infections. Mycobacterium tuberculosis infection was reported very rarely in these patients. This report describes four patients with M. tuberculosis infection identified from 185 adult patients who were diagnosed myelogenous leukemia between January 2003, and December 2004. There was no patient with M. tuberculosis infection from 44 lymphoid leukemia and 11 acute biphenotypic leukemia patients. Sites of infection were all lymph nodes. Three among four patients were presented with lymphadenopathy at initial diagnosis of leukemia, and the other one presented with lymphadenopathy after induction chemotherapy. There was no patient presented with lymphadenopathy during the neutropenic phase. Tuberculous lymphadenitis was presented in a patient with three acute myelogenous leukemia (FAB class 2 M4, 1 M2) and a chronic myelogenous leukemia, accelerated phase. An acute myelogenous leukemia patient had a leukemic cell and tubercle bacilli in the same lymph node. Tuberculosis should also be included as a differential diagnosis in myelogenous leukemia patient with lymphadenopathy, especially in the countries in which the disease is endemic.

Changes in hippocalcin expression in cortical neurons and glial cells by epigallocatechin gallate administration in an animal model of stroke

Ju-Bin Kang(Ju-Bin Kang),Dong-Ju Park(Dong-Ju Park),Jae-You Kim(Jae-You Kim),Hyeun-Gyoung(Hyeun-Gyoung ),Phil-Ok Koh(Phil-Ok Koh) 한국예방수의학회 2023 예방수의학회지 Vol.47 No.2

Ischemic stroke causes brain damage and neuronal cell death by depriving oxygen and nutrients and releasing excessive levels of glutamate and intracellular calcium. Epigallocatechin gallate (EGCG) is a polyphenolic compound present in green tea. It has antioxidant, anti-inflammatory, and neuroprotective effects. Hippocalcin is a calcium binding protein that regulates calcium concentration, neuronal differentiation, neuronal excitability, and neuronal cell death. In this study, we investigated whether EGCG regulates the expression of hippocalcin in neurons and astrocytes after focal cerebral ischemia. Cerebral ischemia was induced by meddle cerebral artery occlusion (MCAO). EGCG (50 mg/kg) or PBS was injected into the abdominal cavity just before MCAO surgery. Neurobehavioral tests were performed to evaluate the effect of EGCG on neurological behavioral deficits 24 h after MCAO surgery. Immunofluorescence staining was performed to evaluate the positive response to hippocalcin in the cerebral cortex after MCAO surgery. We also detected the positive reactions of neuronal nuclear protein (NeuN) and glial fibrillary acidic protein (GFAP) as markers of neuron and astrocyte, respectively. MCAO caused severe neurological impairment and EGCG treatment attenuated these impairments. MCAO damage reduced the number of NeuN-positive cells and increased the number of GFAP-positive cells. This result indicates a decrease in neurons and an increase in astrocytes. However, EGCG alleviated these changes caused by MCAO damage. MCAO reduced the number of hippocalcin-positive cells in neurons and astrocytes, and EGCG treatment attenuated these reductions. Hippocalcin exerts neuroprotective effect through regulating intracellular calcium concentration. In conclusion, EGCG regulates the expression of hippocalcin in neurons and astrocytes and has neuroprotective effects in focal cerebral ischemia.

Poster Session : PS 1513 ; Rheumatology : T Cell Lymphoma in a Ankylosing Spondylitis Patient Treated with Adalimumab

( Jae Bin Kang ),( Ran Song ),( Sang Hoon Lee ),( Jiyoung Choi ),( Yeon Ah Lee ),( Seung Jae Hong ),( Hyung In Yang ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Adalimumab is a tumor necrosis factor (TNF) alpha inhibitor. It has been used to control various autoimmune diseases including rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, Crohn`s disease, ulcerative colitis, etc. It binds to TNF alpha and suppresses TNF receptor`s activity. Down-regulated TNF receptor activity reduces in. ammatory reaction in autoimmune diseases. TNF also has many physiological roles, including tumor surveillance. Therefore, there have always been concerned about the safety of anti-TNF therapy on malignancy. There have been several case reports regarding T cell lymphoma occurring in patients using Adalimumab. However, it is controversial whether TNF alpha inhibitor increases risk of T cell lymphoma or not. Case: 70-year-old Asian male with known Ankylosing Spondylitis with uveitis presented with fever, rash and generalized edema. He was first diagnosed with Ankylosing Spondylitis in 2003. Due to insufficient effect of NSAIDs in controlling his disease activity, Adalimumab was started on November 2008. The patient continues to take it until October 2013. Two months after finishing Adalimumab treatment, he presented with above complaint. On physical examination, he has lymphadenopathy in head, neck, both axilla and inguinal area. Supraclavicular lymph node biopsy was performed, which later showed mature cell lymphoma, with favor of angioimmunoblastic T cell lymphoma.

Chemical and genomic diversity of six <i>Lonicera</i> species occurring in Korea

Kang, Kyo Bin,Kang, Shin-Jae,Kim, Mi Song,Lee, Dong Young,Han, Sang Il,Kim, Tae Bum,Park, Jee Young,Kim, Jinwoong,Yang, Tae-Jin,Sung, Sang Hyun Elsevier 2018 Phytochemistry Vol.155 No.-

<P><B>Abstract</B></P> <P> <I>Lonicera</I> spp. (Caprifoliaceae) are important not only as a common medicinal herb in East Asia but also as one of the most problematic invasive species in North America. In the present study, we performed a systemic analysis of genomic and chemical diversity among six <I>Lonicera</I> species occurring in Korea, <I>L. japonica</I>, <I>L. maackii</I>, <I>L. insularis</I>, <I>L. sachalinensis</I>, <I>L. praeflorens</I>, and <I>L. vesicaria</I>, using chloroplast DNA whole genome shotgun (WGS) sequencing and LC–MS analyses. The phylogenetic and phylochemical relationships did not coincide with each other, but partial consistency could be found among them. InDel-based cDNA marker for authentication was developed based on the genome sequences. Flavonoids, iridoids, and organic acids were identified in the LC–MS analyses, and their inter-species distribution and localization were also revealed.</P> <P><B>Highlights</B></P> <P> <UL> <LI> Phylogeny between six <I>Lonicera</I> species was supposed based on chloroplast genome sequences. </LI> <LI> Specialized metabolites were profiled and compared by LC–MS. </LI> <LI> Partial consistency was found between genomic and chemical phylogeny. </LI> <LI> An Indel-based DNA barcode was developed for authentication of plants. </LI> <LI> Difference in chemotypes was suggested to be caused by ecological roles of iridoids. </LI> </UL> </P> <P><B>Graphical abstract</B></P> <P>[DISPLAY OMISSION]</P>

EBUS-centred versus EUS-centred mediastinal staging in lung cancer: a randomised controlled trial

Kang, Hyo Jae,Hwangbo, Bin,Lee, Geon-Kook,Nam, Byung-Ho,Lee, Hyun-Sung,Kim, Moon Soo,Lee, Jong Mog,Zo, Jae Ill,Lee, Hee Seok,Han, Ji-Youn BMJ Publishing Group Ltd 2014 Thorax Vol.69 No.3

<P><B>Background</B></P><P>The impact of procedure sequence and primary procedure has not been studied in the combined application of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) in lung cancer staging.</P><P><B>Methods</B></P><P>In a randomised controlled trial, 160 patients with histologically confirmed or strongly suspected potentially operable non-small cell lung cancer were enrolled (Group A, n=80, EBUS-centred; Group B, n=80, EUS-centred). EBUS-TBNA and EUS-FNA with an ultrasound bronchoscope were used as the first procedures in Groups A and B, respectively, and secondary procedures (EUS-FNA in Group A, EBUS-TBNA in Group B) were added.</P><P><B>Results</B></P><P>Diagnostic values were evaluated in 148 patients (74 in each group). In Groups A and B the diagnostic accuracy (93.2% (95% CI 87.5% to 99.0%) vs 97.3% (95% CI 93.6% to 101.0%), p=0.245) and sensitivity (85.3% (95% CI 68.9% to 95.0%) vs 92.0% (95% CI 74.0% to 99.0%), p=0.431) in detecting mediastinal metastasis were not statistically different. In Group A, adding EUS-FNA to EBUS-TBNA did not significantly increase the accuracy (from 91.9% to 93.2%, p=0.754) or sensitivity (from 82.4% to 85.3%, p=0.742). In group B, adding EBUS-TBNA to EUS-FNA increased the accuracy (from 86.5% to 97.3%, p=0.016) and sensitivity (from 60.0% to 92.0%, p=0.008). There were no intergroup differences in procedure time, cardiorespiratory parameters during procedures, complications or patient satisfaction.</P><P><B>Conclusions</B></P><P>Using a combination of EBUS-TBNA and EUS-FNA in mediastinal staging, we found that diagnostic values and patient satisfaction were not different between the EBUS-centred and EUS-centred groups. However, the necessity for EBUS-TBNA following EUS suggests that EBUS-TBNA is a better primary procedure in endoscopic mediastinal staging of potentially operable lung cancer.</P><P><B>Trial Registration number</B></P><P>ClinicalTrials.gov number NCT01385111.</P>