The selection criteria for potential bone engineering scaffolds are based chiefly on their relative mechanical comparability to mature bone. In this study, we challenge this notion by obtaining full regeneration of a rabbit ulna critical size defect by employing the elastomeric polymer, poly(glycerol sebacate) (PGS). We tested the regeneration facilitated by PGS alone, PGS in combination with hydroxyapatite particles, or PGS seeded with bone marrow stromal cells. We investigated the quantity and quality of the regenerated bone histologically, by microcomputed tomography and by four-point bending flexural mechanical testing at 8 weeks postimplantation. We conclude that the relatively lower stiffness of this biocompatible elastomer allows a load-transducing milieu in which osteogenesis, matrix deposition, and eventual bone maturation can take place. This study's results suggest that PGS elastomer is an auspicious osteoconductive material for the regeneration of bony defects. These results call for an innovative reassessment of the current art of selection for novel bone scaffold materials.

Introduction Nursing personnel injury related to patient transfer is epidemic, and reduction of injury rates is a national priority. Hierarchical task analysis (HTA) was chosen to address this issue. Method HTA methods were used to create an optimum task set and protocol which consisted of Internet-based education, simulation practice, and debriefing. Participants (N = 71) were randomly assigned to teams to perform simulated transfers. Pre- to postintervention transfer success was evaluated by ergonomic experts. Results Each team improved significantly from pre- to postintervention (N = 19), with every protocol step demonstrating improvement (N = 10). Interrater reliability of the evaluation instrument was calculated (.43–.83). Conclusion Simulation was used successfully to improve transfer success. This approach shows promise in reduction of transfer-related nursing injury.

Purpose: We identified masseter muscle fiber type property differences in subjects with dentofacial deformities.Patients and Methods: Samples of masseter muscle were collected from 139 young adults during mandibular osteotomy procedures to assess mean fiber areas and percent tissue occupancies for the 4 fiber types that comprise the muscle. Subjects were classified into 1 of 6 malocclusion groups based on the presence of a skeletal Class II or III sagittal dimension malocclusion and either a skeletal open, deep, or normal bite vertical dimension malocclusion. In a subpopulation, relative quantities of the muscle growth factors IGF-I and GDF-8 gene expression were quantified by real-time polymerase chain reaction.Results: Fiber properties were not different in the sagittal malocclusion groups, but were very different in the vertical malocclusion groups (P < .0004). There were significant mean fiber area differences for type II (P <= .0004) and type neonatal-atrial (P = .001) fiber types and for fiber percent occupancy differences for both type I-II hybrid fibers and type II fibers (P <= .0004). Growth factor expression differed by gender for IGF-I (P = .02) and GDF-8 (P < .01). The ratio of IGF-I: GDF-8 expression associates with type I and II mean fiber areas.Conclusion: Fiber type properties are very closely associated with variations in vertical growth of the face, with statistical significance for overall comparisons at P <= .0004. An increase in masseter muscle type II fiber mean fiber areas and percent tissue occupancies is inversely related to increases in vertical facial dimension. (C) 2012 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 70: 440-448, 2012

Introduction: Musculoskeletal injury in the workplace is the primary work-related factor in loss of nursing personnel from the workforce. Moving or transferring patients is the dominant contributing event. A simulation educational approach has not been closely studied in this area but may have advantages over traditional approaches. Specific aims were to (1) evaluate the effect of a simulation intervention on success of patient transfers in a clinical setting and (2) measure change in participants' knowledge and attitude as a result of the intervention.Methods: A prospective, observational, longitudinal design was used. Baseline patient transfer observations were conducted on control and intervention units. An optimum task set was developed using hierarchical task analysis methods. Subjects (N = 71) completed pre- and postintervention knowledge and attitude assessments. The intervention consisted of simulated patient transfers using a mannequin, education, and training, followed by repeated simulated transfers using a mannequin with debriefing. Observations of patient transfers in patient care areas were repeated at 4 and 12 weeks.Results: Patient transfer success improved from 66% at baseline to 88% at the 4-week measurement point (t = 7.447, P <= 0.0004). At 12 weeks, transfer success had decreased to 71%, with addition of new employees between weeks 4 and 12 confounding the 12-week measurement. Knowledge improved from a baseline of 65% to 95% postsimulation intervention (z = -6.634, P <= 0.0004). Attitude change was also evaluated with significance seen with 12 of 15 items (P <= 0.05).Conclusions: A simulation intervention was successful in significantly improving knowledge and changing subject perceptions with regard to this task. Skills acquired through simulation successfully transferred to the clinical setting. Improvement in success for patient moves not trained in the simulation laboratory suggests that acquired skills were generalizable and supports application to different settings. (Sim Healthcare 6:84-93, 2011)

Introduction: Musculoskeletal injury in the workplace is the primary work-related factor in loss of nursing personnel from the workforce. Moving or transferring patients is the dominant contributing event. A simulation educational approach has not been closely studied in this area but may have advantages over traditional approaches. Specific aims were to (1) evaluate the effect of a simulation intervention on success of patient transfers in a clinical setting and (2) measure change in participants' knowledge and attitude as a result of the intervention. Methods: A prospective, observational, longitudinal design was used. Baseline patient transfer observations were conducted on control and intervention units. An optimum task set was developed using hierarchical task analysis methods. Subjects (N = 71) completed pre- and postintervention knowledge and attitude assessments. The intervention consisted of simulated patient transfers using a mannequin, education, and training, followed by repeated simulated transfers using a mannequin with debriefing. Observations of patient transfers in patient care areas were repeated at 4 and 12 weeks. Results: Patient transfer success improved from 66% at baseline to 88% at the 4-week measurement point (t = 7.447, P ≤ 0.0004). At 12 weeks, transfer success had decreased to 71%, with addition of new employees between weeks 4 and 12 confounding the 12-week measurement. Knowledge improved from a baseline of 65% to 95% postsimulation intervention (z = −6.634, P ≤ 0.0004). Attitude change was also evaluated with significance seen with 12 of 15 items (P ≤ 0.05). Conclusions: A simulation intervention was successful in significantly improving knowledge and changing subject perceptions with regard to this task. Skills acquired through simulation successfully transferred to the clinical setting. Improvement in success for patient moves not trained in the simulation laboratory suggests that acquired skills were generalizable and supports application to different settings.

Dentin matrix phosphoprotein 1 (DMP1) is a non-collagenous, acidic extracellular matrix protein expressed chiefly in bone and dentin. We examined the DMP1 ability to engage cell-surface receptors and subsequently activate intracellular signaling pathways. Our data indeed show that the presence of extracellular DMP1 triggers focal adhesion point formation in human mesenchymal stem cells and osteoblast-like cells. We determine that DMP1 acts via interaction with αvβ3 integrin and stimulates phosphorylation of focal adhesion kinase. Further biochemical characterization confirms the activation of downstream effectors of the MAPK pathways, namely ERK and JNK, after DMP1 treatment. This activation is specifically inhibitable and can also be blocked by the addition of anti-αvβ3 integrin antibody. Furthermore, we show that extracellular treatment with DMP1 stimulates the translocation of phosphorylated JNK to the nucleus and a concomitant up-regulation of transcriptional activation by phosphorylated c-Jun. The evidence presented here indicates that DMP1 is specifically involved in signaling via extracellular matrix-cell surface interaction. Combined with the published DMP1-null data (Feng, J. Q., Ward, L. M., Liu, S., Lu, Y., Xie, Y., Yuan, B., Yu, X., Rauch, F., Davis, S. I., Zhang, S., Rios, H., Drezner, M. K., Quarles, L. D., Bonewald, L. F., and White, K. E. (2006) Nat. Genet. 38, 1310–1315) it can be hypothesized that DMP1 could be a key effector of ECM-osteocyte signaling.

Nano-structured calcium phosphate (NanoCaP) particles have been proven to be a powerful means of non-viral gene delivery. In order to better understand the mechanisms through which NanoCaPs-mediated mammalian cell transfection is achieved, we have sought to define the intracellular trafficking pathways involved in the cellular uptake and intracellular processing of these particles. Previous work has indicated that NanoCaP-DNA complexes are most likely internalized via endocytosis, however the subsequent pathways involved have not been determined. Through the use of specific inhibitors, we show that endocytosis of NanoCaP particles is both clathrin- and caveolae-dependent, and suggest that the caveolaer mechanism is the major contributor. We demonstrate colocalization of NanoCaP-pDNA complexes with known markers of both clathrin-coated and caveolar vesicles. Furthermore, through the use of quantitative flow cytometry, we present the first work in which the percent internalization of CaP-DNA complexes into cells is quantified. The overall goal of this research is to foster the continued improvement of NanoCaP-based gene delivery strategies.

ABSTRACTPurpose: As dentists embrace evidence‐based clinical practice, we place increased emphasis on patient values. Standards like Angle Classification are not related to patient perceptions of the tangible benefits of treatment. This study quantifies the differences dentists and patients perceive in orthodontic treatment outcome.Materials and Methods: A survey is used to quantify a patient's perception of orthodontic treatment. It was completed by 30 patients who completed treatment at the University of Pittsburgh School of Dental Medicine. Their responses were compared with the perceptions of five orthodontists, three general dentists, and two prosthodontists.Results: Multivariate analysis of variance found the differences between and within the subjects to be significant at p < 0.004. Univariate analysis of variance of the initial scores showed the data to be significant at p < 0.002 and pairwise comparisons showed significant mean differences. Final score analysis of variance was significant at p < 0.001 and pairwise comparison showed significant mean differences.Conclusions: Patients and general dentists have a significantly less favorable initial perception of their dental esthetics and function when compared with orthodontists. Final scores of esthetic and functional perceptions between the patients and all three dentist groups showed significant differences, with patients perceiving the results of their treatment more favorably than practitioners.CLINICAL SIGNIFICANCEThe data herein elucidates differences in the value systems of professionals and patients. It is meant to encourage dentists to consider whether these differences justify the persistence of traditional orthodontic treatment goals or if treatment planning should incorporate consideration of each individual patient's preferences to maximize utility.(J Esthet Restor Dent 24:40–52, 2012)

Background. Mitochondrial alterations occur in skeletal muscle fibers throughout the normal aging process, resulting from increased accumulation of reactive oxide species (ROS). These result in respiratory chain abnormalities, which decrease the oxidative capacity of muscle fibers, leading to decreased contractile force, sarcopenia, or fiber necrosis. Intrinsic laryngeal muscles are a cranial muscle group that possesses some distinctive genotypic, phenotypic, and physiologic properties. Their susceptibility to mitochondrial alterations resulting from biological processes that increase levels of oxidative stress may be one of these distinctive characteristics.Objectives. The incidence of cytochrome c oxidase (COX) deficiency (COX-) was determined in human posterior cricoarytenoid (PCA) muscle when compared with the human thyrohyoid (TH) muscle, an extrinsic laryngeal muscle that served as "control" muscle. Ten PCA and 10TH muscles were harvested postlaryngectomy from 10 subjects ranging in age from 55 to 86 years. Differences in COX- were compared within and between muscle types using tissue section staining and standard morphometric analysis.Results and Conclusions. COX- fibers were identified in both the PCA and TH muscles. The PCA muscle had 10 times as may affected fibers as the TH muscle, with significant differences in COX- found between muscle type and fiber type (P = 0.003). Almost all of this effect was the result of elevated levels of COX- in type 1 fibers from the PCA muscle (P = 0.002) that showed a strong positive correlation with increased age. These results suggest that increased mitochondrial alterations may occur in the PCA muscle during normal aging.

The objective of this study was to examine the public health relevance of the prevalence of dental fear in Kuwait and the resultant barrier that it creates regarding access to dental care. The study analysis demonstrated a high prevalence of dental fear and anxiety in the Kuwaiti population and a perceived need for anesthesia services by dental care providers. The telephone survey of the general population showed nearly 35% of respondents reported being somewhat nervous, very nervous, or terrified about going to the dentist. In addition, about 36% of the population postponed their dental treatment because of fear. Respondents showed a preference to receive sedation and anesthesia services as a means of anxiety relief, and they were willing to go to the dentist more often when such services were available. People with high fear and anxiety preferred to receive some type of medication to relieve their anxiety. In conclusion, the significance and importance of the need for anesthesia services to enhance the public health of dental patients in Kuwait has been demonstrated, and improvements are needed in anesthesia and sedation training of Kuwaiti dental care providers.

The goal of this study was to identify and quantify complications occurring with the administration of anesthesia for the dental treatment of patients with special needs. Anesthesia providers completed a standardized evaluation form, delineating possible complications for 202 consecutive ambulatory patients receiving anesthesia in a special needs clinic. Statistical analysis of four types of administered anesthesia showed that the overall complication rate was 23.8%. Evaluation of the data showed complications that were considered either mild (95.8%), or moderate (4.2%), while no reports of severe complications occurred. Airway obstruction and nausea/vomiting were the most frequently encountered complications. Variables found to affect the incidence of anesthetic complications included ASA classification, anesthetic technique, Mallampati airway classification, and type of dental procedure performed.An evaluation of the results of the study showed that the majority of complications that occurred with anesthesia during care of patients with special needs were mild and did not lead to severe adverse events. Our findings show that anesthesia administered during dental treatment for patients with special needs is safe and effective.

Purpose: Tobacco use screening and brief intervention is recognised as an effective available preventive health service; yet, this service is still not routinely offered to dental patients by clinicians, despite dental schools generally providing some form of tobacco cessation counselling (TCC) by including it in their dental curriculum. A pilot study was therefore carried out to more clearly identify barriers that prevented the delivery of this service to tobacco-using patients at the University of Pittsburgh School of Dental Medicine and educational initiatives that might overcome these barriers. Materials and Methods: A survey of faculty and students asked participants to rank their knowledge, preparation and comfort levels in performing TCC as well as their belief as to the importance of such training in the dental curriculum. Six months following training and practice opportunities, surveys were again administered to participants. Each individual's pre- and post-TCC training surveys were reviewed and difference in response to each item was calculated. Results: The results of the present study show that students feel more prepared, that the time required to provide TCC was less than anticipated and that training in TCC is an important part of dental education to a greater extent after the pilot study than before. Conclusions: TCC training and practice opportunities for clinical application were effective in this pilot study in improving students' attitudes towards cited barriers.

Introduction: Numerous in-vitro studies have been conducted with various archwire-ligation combinations to evaluate the effect of wire size and ligation method on frictional resistance. The aim of this in-vitro study was to compare the frictional resistance during sliding mechanics with Gianelly-type stainless steel working wires, Leone slide ligature, conventional elastic ligature, and stainless steel (SS) ligature, and a conventional bracket and active and passive self-ligating brackets. Methods: Three ligation methods with Victory (V) brackets-Leone (VLeone), conventional (regular) elastic (VReg), and SS (VSS)-were used with standard SS brackets, and 2 self-ligating brackets-Damon MX (Ormco/"A", St. Paul, Minn) (DMX) and In-Ovation R (GAC Intl., Bohemia, NY)-were used with 2 rectangular SS wires (0.016 x 0.022 and 0.018 x 0.022 in). Therefore, 5 ligation methods and 2 wire sizes were evaluated with respect to their effects on frictional resistance. Results: No statistically significant differences were found between the SS ligation method and DMX (neither produced measurable static friction). For the wire size 0.016 x 0.022-in SS, the DMX and SS produced significantly less static friction than the In-Ovation R, VLeone, and VReg. The In-Ovation R produced significantly less friction than both the VLeone and VReg, whereas the VLeone produced significantly less friction than the VReg. For the wire size 0.018 x 0.022-in SS, the overall results were the same, except that the In-Ovation R produced significantly more friction than the VLeone. An increase in wire size (from 0.016 x 0.022 to 0.018 x 0.022 in) led to an increase in friction in all bracket-archwire combinations (except DMX and VSS, which showed no measurable friction at either wire size). Conclusions: The Leone slide ligature showed less friction at both wire sizes than VReg; however, it showed significantly more friction than both DMX and VSS. DMX and VSS brackets produced no measurable friction with either 0.016 x 0.022-in or 0.018 x 0.022-in wires. An increase in wire size (from 0.016 x 0.022 to 0.018 x 0.022 in) led to an increase in friction in all bracket-archwire combinations (excluding DMX and VSS, which showed no measurable friction at either wire size). (Am J Orthod Dentofacial Orthop 2010;138:67-71)

Sialadenosis (sialosis) has been associated most often with alcoholic liver disease and alcoholic cirrhosis, but a number of nutritional deficiencies, diabetes, and bulimia have also been reported to result in sialadenosis. The aim of this study was to determine the prevalence of sialadenosis in patients with advanced liver disease. Patients in the study group consisted of 300 candidates for liver transplantation. Types of liver disease in subjects with clinical evidence of sialadenosis were compared with diagnoses in cases who had no manifestations of sialadenosis. The data were analyzed for significant association. Sialadenosis was found in 28 of the 300 subjects (9.3%). Among these 28 cases, 11 (39.3%) had alcoholic cirrhosis. The remaining 17 (60.7%) had eight other types of liver disease. There was no significant association between sialadenosis and alcoholic cirrhosis (P = 0.389). These findings suggest that both alcoholic and non-alcoholic cirrhosis may lead to the development of sialadenosis. Advanced liver disease is accompanied by multiple nutritional deficiencies which may be exacerbated by alcohol. Similar metabolic abnormalities may occur in patients with diabetes or bulimia. Malnutrition has been associated with autonomic neuropathy, the pathogenic mechanism that has been proposed for sialadenosis.

Objectives: Anatomic segmentectomy is increasingly being considered as a means of achieving an R0 resection for peripheral, small, stage I non-small-cell lung cancer. In the current study, we compare the results of video-assisted thoracic surgery (n = 104) versus open (n = 121) segmentectomy in the treatment of stage I nonsmall-cell lung cancer.Methods: A total of 225 consecutive anatomic segmentectomies were performed for stage IA (n = 138) or IB (n = 87) non-small-cell lung cancer from 2002 to 2007. Primary outcome variables included hospital course, complications, mortality, recurrence, and survival. Statistical comparisons were performed utilizing the t test and Fisher exact test. The probability of overall and recurrence-free survival was estimated with the Kaplan-Meier method, with significance being estimated by the log-rank test.Results: Mean age (69.9 years) and gender distribution were similar between the video-assisted thoracic surgery and open groups. Average tumor size was 2.3 cm (2.1 cm video-assisted thoracic surgery; 2.4 cm open). Mean follow-up was 16.2 (video-assisted thoracic surgery) and 28.2 (open) months. There were 2 perioperative deaths (2/225; 0.9%), both in the open group. Video-assisted thoracic surgery segmentectomy was associated with decreased length of stay (5 vs 7 days, P < .001) and pulmonary complications (15.4% vs 29.8%, P = .012) compared with open segmentectomy. Overall mortality, complications, local and systemic recurrence, and survival were similar between video-assisted thoracic surgery and open segmentectomy groups.Conclusions: Video-assisted thoracic surgery segmentectomy can be performed with acceptable morbidity, mortality, recurrence, and survival. The video-assisted thoracic surgery approach affords a shorter length of stay and fewer postoperative pulmonary complications compared with open techniques. The potential benefits and limitations of segmentectomy will need to be further evaluated by prospective, randomized trials. (J Thorac Cardiovasc Surg 2009;138:1318-25)

BACKGROUND:Anatomic segmentectomy for stage I non-small cell lung cancer (NSCLC) offers the potential of surgical cure with preservation of lung function. This may be of particular importance in elderly NSCLC patients with declining cardiopulmonary status and a limited life expectancy.METHODS:The study compared outcomes of 78 elderly patients (aged > 75 years) with stage I NSCLC undergoing segmentectomy and 106 undergoing lobectomy for stage I NSCLC from 2002 to 2007. Primary outcome variables included perioperative morbidity and mortality, hospital course, recurrence patterns, and survival.RESULTS:Age, gender, tumor histology, and surgical approach were similar between groups. Comorbidities were similar except for a higher incidence of chronic obstructive pulmonary disease and diabetes in segmentectomy patients. The tumors in the lobectomy group were significantly larger (3.5 vs 2.5 cm, p = 0.0001). Operative mortality was 1.3% for segmentectomy and 4.7% for lobectomy. Segmentectomy patients had fewer major complications (11.5% vs 25.5%, p = 0.02). There were no differences in median hospitalization (7 vs 6 days). The estimated overall survival at 2, 3, and 5 years was 76%, 69%, and 46% for segmentectomy patients and 68%, 59%, and 47% for lobectomy patients (p = 0.28). The 5-year disease-free survival was equivalent (segmentectomy, 49.8%; lobectomy, 45.5%; p = 0.80).CONCLUSIONS:Anatomic segmentectomy can be performed safely in elderly patients with early-stage NSCLC. This approach is associated with reduced perioperative complications and comparable oncologic efficacy compared with lobectomy in older patients with a limited life expectancy.

Background. The diagnostic yield and accuracy of new approaches to diagnose cancer should focus on comparison with established surgical techniques. Our objective was to evaluate the diagnostic performance of endobronchial ultrasound (EBUS) to detect cancer in patients with radiographically abnormal mediastinal lymph nodes.Methods. The medical records of patients who underwent EBUS and had abnormal mediastinal lymph nodes (short-axis > 1 cm and [or] positron emission topography-positive) over a 25 month period at the University of Pittsburgh were reviewed. Demographic and clinical data, cytology, and pathology results were entered in a database and analyzed.Results. A total of 172 patients [male to female = 1.8:1; median age, 67 years (range, 20 to 90]) were included. The diagnostic yield of EBUS cytology was 79.7% (137 of 172). Pathologic testing was available in 68% (117 of 172) and 82% (96 of 117) had a diagnostic EBUS. The diagnostic accuracy of EBUS was 91.7%. The sensitivity, specificity, positive (PPV) and negative (NPV) predictive values were 88.1% (95% confidence interval [CI], 77.3 to 94.3), 100% (95% CI, 85.9 to 100), 100% (95% CI, 92.4 to 100), and 80.6% (95% CI, 63.4 to 91.2), respectively. In 67 patients who had a suspected or biopsy-proven primary lung cancer, diagnostic yield was 86.6% and accuracy was 94.8%. In this subgroup the sensitivity, specificity, PPV, and NPV were 93% (95% CI, 76.5 to 98.9), 100% (95% CI, 69.9 to 100), 100% (95% CI, 85 to 100), and 83.3% (95% CI, 56.2 to 97.5).Conclusions. Diagnostic performance data support the clinical usefulness of EBUS in the evaluation of patients with a radiographically abnormal mediastinum. It should be considered complementary to mediastinoscopy rather than substitutive. (Ann Thorac Surg 2009; 88:896-902) (C) 2009 by The Society of Thoracic Surgeons

Objective. The authors conducted a randomized, double-blind clinical trial to evaluate pulpal anesthesia achieved after mandibular infiltration of five commonly marketed dental local anesthetic formulations as compared with a control formulation of lidocaine with epinephrine.Methods. The authors evaluated 2 percent lidocaine with 1:100,000 epinephrine (L100) against 4 percent articaine with 1:100,000 epinephrine (A100), 4 percent articaine with 1:200,000 epinephrine (A200), 4 percent prilocaine with 1:200,000 epinephrine (P200), 3 percent mepivacaine without vasoconstrictor (Mw/o) and 0.5 percent bupivacaine with 1:200,000 epinephrine (B200). This repeated-treatment trial involved 18 healthy participants. The investigators administered mandibular infiltration injections (six sessions per participant) of 0.9 milliliters of anesthetic into the buccal fold adjacent to the distal root of the mandibular first molar. The authors determined anesthetic efficacy across a 20-minute period by measuring changes in sensory threshold to electrical pulp test (EPT) stimulation.Results. Twelve female and six male participants (mean age, 24.9 years; range, 18-53 years) completed the study. The maximum mean increase from baseline of EPT measurements for the six formulations were 43.5 percent for L100, 44.8 percent for B200, 51.2 percent for P200, 66.9 percent for A200, 68.3 percent for Mw/o and 77.3 percent for A100 (A100 versus L100, P = .029). Adverse reactions were minor and not formulation dependent.Conclusions and Clinical Implications. The authors found that mandibular infiltration with 0.9 mL of the tested dental anesthetics could induce only partial pulpal anesthesia, a level likely to be inadequate for most dental procedures. When compared with L100, only the A100 induced statistically greater pulpal anesthesia after mandibular buccal infiltration.

OBJECTIVE:The study objective was to determine the clinical usefulness and accuracy of endobronchial ultrasound-guided needle aspiration of mediastinal and hilar lymph nodes.METHODS:A retrospective analysis of a thoracic surgery unit's experience was performed.RESULTS:In a period of 19 months, 75 patients underwent the procedure (mean age = 65.5 +/- 1.6 years; male to female = 2:1) most commonly for mediastinal lymphadenopathy in the setting of diagnosed or suspected lung cancer. It was diagnostic in 68.9% after rapid on-site evaluation and 74.3% after final cytologic examination. The rapid on-site evaluation and final cytology results were discordant in 16.2% (P < .001). In 50 cases, the needle aspirate cytology could be compared with pathology results. The sensitivity and specificity for the diagnosis of cancer were 85% and 100%, respectively. The false-negative rate endobronchial ultrasound cytology was 8.1%. Mediastinal lymph node station 7 was most commonly biopsied. The stations with the highest diagnostic yield were: 11R, 3, 10L, and 7. Of the patients with a positive positron emission tomography scan with suspected clinical stage III lung cancer, cancer was downstaged in 40% after endobronchial ultrasound.CONCLUSION:Endobronchial ultrasound-guided needle aspiration is a clinically useful minimally invasive option for lung cancer staging and evaluation of mediastinal lymphadenopathy. The procedure should be considered complementary to mediastinoscopy.