The IASLC Staging and Prognostic Factors Committee has collected a new database of 94,708 cases donated from 35 sources in 16 countries around the globe. This has now been analysed by our statistical partners at Cancer Research And Biostatistics and, in close collaboration with the members of the committee proposals have been developed for the T, N, and M categories of the 8th edition of the TNM Classification for lung cancer due to be published late 2016. In this publication we describe the methods used to evaluate the resultant Stage groupings and the proposals put forward for the 8th edition.

An extensive analysis has produced stage classification proposals for lung cancer with a robust degree of discriminatory consistency and general applicability. Nevertheless, external validation is encouraged to identify areas of strength and weakness; a sound validation should have discriminatory ability and be based on an independent data set of adequate size and sufficient follow-up with enough patients for each subgroup.

scopia Respiratoria, con el objetivo de proporcionar conocimientos para el uso efectivo y seguro de la broncoscopia en pacientes con sospecha o con confirmación de la infección por COVID-19. Es prioritario proporcionar la mayor seguridad a nuestros pacientes, a los sanitarios que los atienden y a la comunidad en general. En este momento de pandemia, la información de la que disponemos acerca del uso de la broncoscopia en este tipo de pacientes se basa en la experiencia de otros centros y países, y las publicaciones científicas son escasas. El objetivo de este documento es recoger esas experiencias y, en base a las recomendaciones de los organismos oficiales, ofrecer un documento de ayuda para la práctica clínica diaria.

No abstract

No abstract

No abstract

Background: Knowing the cost of hospitalizations for exacerbation in bronchiectasis patients is essential to perform cost-effectiveness studies of treatments that aim to reduce exacerbations in these patients. Objectives: To find out the mean cost of hospitalizations due to exacerbations in bronchiectasis patients, and to identify factors associated with higher costs. Methods: Prospective, observational, multicenter study in adult bronchiectasis patients hospitalized due to exacerbation. All expenses from the patients’ arrival at hospital to their discharge were calculated: diagnostic tests, treatments, transferals, home hospitalization, admission to convalescence centers, and hospitals’ structural costs for each patient (each hospital’s tariff for emergencies and 70% of the price of a bed for each day in a hospital ward). Results: A total of 222 patients (52.7% men, mean age 71.8 years) admitted to 29 hospitals were included. Adding together all the expenses, the mean cost of the hospitalization was EUR 5,284.7, most of which correspond to the hospital ward (86.9%), and particularly to the hospitals’ structural costs. The adjusted multivariate analysis showed that chronic bronchial infection by Pseudomonas aeruginosa, days spent in the hospital, and completing the treatment with home hospitalization were factors independently associated with a higher overall cost of the hospitalization. Conclusions: The mean cost of a hospitalization due to bronchiectasis exacerbation obtained from the individual data of each episode is higher than the cost per process calculated by the health authorities. The most determining factor of a higher cost is chronic bronchial infection due to P. aeruginosa, which leads to a longer hospital stay and the use of home hospitalization.

Glutamic acid decarboxylase (GAD), the enzyme that catalyzes the conversion of glutamate to ␥-aminobutyric acid (GABA), is expressed in GABA-secreting neurons and pancreatic ␤ cells. 1 Anti-GAD antibodies (GAD Abs) have been described in patients with type 1 diabetes mellitus and patients with two CNS disorders, stiff-person syndrome and cerebellar ataxia associated with polyendocrine autoimmunity. 2 We report a patient with paraneoplastic encephalomyelitis associated with a pancreatic tumor and GAD Abs.Case report. A 67-year-old man presented paresthesias and numbness in hands, feet, and perioral region. Over the next 2 weeks, he developed gait instability that required bilateral support for walking. The general examination was unremarkable. The neurologic examination showed gaze-evoked downbeat nystagmus. Deep tendon reflexes were absent in the legs. There was hypoesthesia in glove and stocking distribution, with decreased vibration and joint position sense in the fingers and toes. He showed truncal and gait ataxia and moderate limb dysmetria. Routine hematologic and biochemical analysis were normal. CSF analysis revealed a protein level of 314 mg/dL, 11 lymphocytes/ mm 3 , and negative oligoclonal IgG bands. Serum and CSF serologies and cultures ruled out an infectious etiology. Antineuronal antibodies (Hu, Yo, Ri, Ma 1 and 2, CV2, and amphiphysin antibodies) were negative, but GAD Abs, detected by immunohistochemistry and RIA, 2 were present in serum (1/80,000) and CSF (1/800). No other autoantibodies were detected either by immunohistochemistry or immunoblot of neuronal extracts. Nerve conduction studies demonstrated absent sensory nerve action potential in the legs with normal motor nerve and F-wave studies. Brain MRI was normal. A CT scan of the abdomen demonstrated a mass (5.5 ϫ 3 ϫ 5 cm) in the body of the pancreas without evidence of metastasis. The patient underwent a resection of the corpus and cauda of the pancreas combined with splenectomy. A histopathologic examination revealed a neoplasm of the pancreatic body, which showed an intense infiltration of inflammatory cells (figure) and a positive immunostaining for synaptophysin and chromogranin A. The tumor was classified as a well-differentiated, nonfunctioning pancreatic endocrine neoplasm. Symptoms worsened over the ensuing months. He also developed painful spasms in the left leg with fixed dorsiflexion posture of the foot. A new electromyogram demonstrated persistent motor activity in the left leg. Symptoms did not improve after several courses of IV immunoglobulins; he developed confusion and agitation and died from aspiration bronchopneumonia.The expression of GAD antigen by the patient's tumor was demonstrated by the characteristic immunoreactivity of the tumor cells after incubation with GAD-6 monoclonal antibody (Hybrioma Bank, Iowa City, IA) (see figure) or biotinylated IgG of a patient with high titers of GAD Abs. Specificity of staining for GAD antigen was confirmed by competition experiments in which binding of the GAD-6 monoclonal anti...