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.

Bronchiectasis in adults is a chronic disorder associated with poor quality of life and frequent exacerbations in many patients. There have been no previous international guidelines.The European Respiratory Society guidelines for the management of adult bronchiectasis describe the appropriate investigation and treatment strategies determined by a systematic review of the literature.A multidisciplinary group representing respiratory medicine, microbiology, physiotherapy, thoracic surgery, primary care, methodology and patients considered the most relevant clinical questions (for both clinicians and patients) related to management of bronchiectasis. Nine key clinical questions were generated and a systematic review was conducted to identify published systematic reviews, randomised clinical trials and observational studies that answered these questions. We used the GRADE approach to define the quality of the evidence and the level of recommendations. The resulting guideline addresses the investigation of underlying causes of bronchiectasis, treatment of exacerbations, pathogen eradication, long term antibiotic treatment, anti-inflammatories, mucoactive drugs, bronchodilators, surgical treatment and respiratory physiotherapy.These recommendations can be used to benchmark quality of care for people with bronchiectasis across Europe and to improve outcomes.

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.

Malignant pleural effusions (MPE) are a common pathology, treated by respiratory physicians and thoracic surgeons alike. In recent years, several well-designed randomised clinical trials have been published that have changed the landscape of MPE management. The European Respiratory Society (ERS) and the European Association for Cardio-Thoracic Surgery (EACTS) established a multidisciplinary collaboration of clinicians with expertise in the management of MPE with the aim of producing a comprehensive review of the scientific literature.Six areas of interest were identified, including the optimum management of symptomatic MPE, management of trapped lung in MPE, management of loculated MPE, prognostic factors in MPE, whether there is a role for oncological therapies prior to intervention for MPE and whether a histological diagnosis is always required in MPE.The literature revealed that talc pleurodesis and indwelling pleural catheters effectively manage the symptoms of MPE. There was limited evidence regarding the management of trapped lung or loculated MPE. The LENT score was identified as a validated tool for predicting survival in MPE, with Brims' prognostic score demonstrating utility in mesothelioma prognostication. There was no evidence to support the use of oncological therapies as an alternative to MPE drainage, and the literature supported the use of tissue biopsy as the gold standard for diagnosis and treatment planning.

Malignant pleural effusions (MPE) are a common pathology, treated by respiratory physicians and thoracic surgeon alike. In recent years, several well-designed, randomised clinical trials have been published that have changed the landscape of MPE management. The European Respiratory Society (ERS) and the European Association for Cardio-Thoracic Surgery (EACTS) established a multi-disciplinary collaboration of clinicians with expertise in the management of MPE with the aim of producing a comprehensive review of the scientific literature.Six areas of interest were identified, including the optimum management of symptomatic MPE, management of trapped lung in MPE, management of loculated MPE, prognostic factors in MPE, whether there is a role for oncological therapies prior to intervention for MPE, and whether a histological diagnosis is always required in MPE.The literature revealed that talc pleurodesis and indwelling pleural catheters are effective at managing the symptoms of MPE. There was limited evidence regarding the management of trapped lung or loculated MPE. The LENT score was identified as a validated tool for predicting survival in MPE, with Brims' prognostic score demonstrating utility in mesothelioma prognostication. There was no evidence to support the use of oncological therapies as an alternative to MPE drainage, and the literature supported the use of tissue biopsy as the gold standard for diagnosis and treatment planning.

We detail the sensitivity of the proposed liquid xenon DARWIN observatory to solar neutrinos via elastic electron scattering. We find that DARWIN will have the potential to measure the fluxes of five solar neutrino components: pp, $$^7$$ 7 Be, $$^{13}$$ 13 N, $$^{15}$$ 15 O and pep. The precision of the $$^{13}$$ 13 N, $$^{15}$$ 15 O and pep components is hindered by the double-beta decay of $$^{136}$$ 136 Xe and, thus, would benefit from a depleted target. A high-statistics observation of pp neutrinos would allow us to infer the values of the electroweak mixing angle, $$\sin ^2\theta _w$$ sin 2 θ w , and the electron-type neutrino survival probability, $$P_{ee}$$ P ee , in the electron recoil energy region from a few keV up to 200 keV for the first time, with relative precision of 5% and 4%, respectively, with 10 live years of data and a 30 tonne fiducial volume. An observation of pp and $$^7$$ 7 Be neutrinos would constrain the neutrino-inferred solar luminosity down to 0.2%. A combination of all flux measurements would distinguish between the high- (GS98) and low-metallicity (AGS09) solar models with 2.1–2.5$$\sigma $$ σ significance, independent of external measurements from other experiments or a measurement of $$^8$$ 8 B neutrinos through coherent elastic neutrino-nucleus scattering in DARWIN. Finally, we demonstrate that with a depleted target DARWIN may be sensitive to the neutrino capture process of $$^{131}$$ 131 Xe.

The International Standards for Tuberculosis Care define the essential level of care for managing patients who have or are presumed to have tuberculosis, or are at increased risk of developing the disease. The resources and capacity in the European Union (EU) and the European Economic Area permit higher standards of care to secure quality and timely TB diagnosis, prevention and treatment. On this basis, the European Union Standards for Tuberculosis Care (ESTC) were published in 2012 as standards specifically tailored to the EU setting. Since the publication of the ESTC, new scientific evidence has become available and, therefore, the standards were reviewed and updated.A panel of international experts, led by a writing group from the European Respiratory Society (ERS) and the European Centre for Disease Prevention and Control (ECDC), updated the ESTC on the basis of new published evidence. The underlying principles of these patient-centred standards remain unchanged. The second edition of the ESTC includes 21 standards in the areas of diagnosis, treatment, HIV and comorbidities, and public health and prevention.The ESTC target clinicians and public health workers, provide an easy-to-use resource and act as a guide through all the required activities to ensure optimal diagnosis, treatment and prevention of TB.

@ERSpublicationsThe second lung resection is a valuable option for post-operative lung cancer recurrence http://ow.ly/U8z3cSurgical treatment offers the best chances for long-term survival in patients with primary nonsmall cell lung cancer (NSCLC). However, long-term survival after surgery remains less than 50%, mostly due to a 30-77% rate of tumour recurrence. Unlike the distant type of recurrence that is treated nonsurgically in the vast majority of patients, local or loco-regional recurrence, which occurs in 4.6-24% of patients after complete resection (∼80% of cases in the first 2 years) [1], raises several concerns related to the optimal therapeutic approach.Unfortunately, literature data are not always helpful in practice. For example, 5-year loco-regional recurrence rates are between 15 and 38.5% [2], and the incidence of local recurrence in early-stage lung cancer of 10-15% [3], or a mean disease-free interval of 14.1-19.8 months, that is similar to distant recurrent disease [4]. Failure to demonstrate the advantage of complete lymphadenectomy over nodal sampling in terms of local recurrence or survival in patients operated for T1-2, N0 or T1-2, N1 disease, makes the clinical approach more complex [5]. Moreover, the impact of intensified follow-up on overall survival or local recurrence detection could not be clearly demonstrated. In ∼50-67% of patients, recurrence will appear before a scheduled control because of the onset of symptoms [6].Finally, switching to seventh edition of the TNM (tumour, node, metastasis) staging system automatically led to the stage migration, reaching 21% in some studies. The only study of the role of computed tomography (CT) in post-operative recurrence detection demonstrated a high negative predictive value of 95%, but a positive predictive value of only 53% (94% sensitivity and 87% specificity) [7]. For positron emission tomography, although it is more sensitive than CT in detecting recurrent tumours (97-100%), variations of the cut-off values for the standardised uptake value (⩾4.5-⩾10) make its clinical application difficult, together with its specificity (62-100%) that is lower than for CT.The role of prognostic factors after surgery is more evidence-based, owing to awareness of the poor 5-year survival of patients in stages IA and IB (73% and 58%, respectively). This also applies to the high recurrence rate in patients with stage I after complete resection (25-50%) [8]. The results of these studies really helped to identify patients who would probably benefit from adjuvant therapy.Among tumour markers, although increased serum concentrations of carcinoembryonic antigen (CEA) are rare (17%), persistently high post-operative CEA levels were found to be a strong indicator of poor prognosis. In 55-70% of patients with CEA values of 5-10 ng·mL , an early recurrence will develop [9].Of the many analysed clinical and pathological prognostic factors, vascular invasion, lymphatic vessel and visceral pleural invasion have been identified as clearly unfavourable in terms of surviv...