At our centre, 1/20 patients with lung cancer have concomitant IPF. The majority of these tumours are small in size, peripheral in location and squamous cell carcinoma; in an area of honey combing. The outcome for concomitant lung cancer and IPF regardless of stage or therapy is poor.

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Peripheral lung nodules remain challenging for accurate localization and diagnosis. Once identified, there are many strategies for diagnosis with heterogeneous risk benefit analysis. Traditional strategies such as conventional bronchoscopy have poor performance in locating and acquiring the required tissue. Similarly, while computerized-assisted transthoracic needle biopsy is currently the favored diagnostic procedure, it is associated with complications such as pneumothorax and hemorrhage. Video-assisted thoracoscopic and open surgical biopsies are invasive, require general anesthesia and are therefore not a first-line approach. New techniques such as ultrathin bronchoscopy and image-based guidance technologies are evolving to improve the diagnosis of peripheral lung lesions. Virtual bronchoscopy and electromagnetic navigation systems are novel technologies based on assisted-computerized tomography images that guide the bronchoscopist toward the target peripheral lesion. This article provides a comprehensive review of these emerging technologies.

Mung bean [Vigna radiata (L.) Wilczek] is an important cash pulse crop extensively cultivated in the arid region of Pakistan, which encounters intimidating charcoal rot disease caused by Macrophomina phaseolina (Tassi) Goid. The current research was conducted to check the potential of Zn (1.25, 2.44 and 5 mg kg −1) and FYM [farmyard manure (1% and 2%)] in mono-, bi-and trilateral interaction in managing disease and improving yield. Suppression of plant immunity by M. phaseolina was indicated by the change in activities of antioxidant enzymes (CAT and SOD) and cell wall strengthening enzymes (POX and PAL) that revealed inability of the protein receptor to identify the pathogen elicitor. FYM improved soil physicochemical properties and beneficial microbes activity, which released antimicrobial protein-and plant defense-stimulating protein and in response to ROS (reactive oxygen species) signaling molecules plant susceptibility was reduced. However, Zn as a co-factor chastened the ROS in stressed cells by upregulation of antioxidant enzymes in favor of the plant. The complex interaction of FYM and Zn potentially hijacked the further multiplication of pathogen. Finally, soil amendment improved biological attributes and grain yield to profitable farming in terms of harvest index percentage and benefit-cost ratio.

Background Computed tomography (CT) helps physicians locate and diagnose pathological conditions. In some conditions, having an airway segmentation method which facilitates reconstruction of the airway from chest CT images can help hugely in the assessment of lung diseases. Many efforts have been made to develop airway segmentation algorithms, but methods are usually not optimized to be reliable across different CT scan parameters.MethodsIn this paper, we present a simple and reliable semi-automatic algorithm which can segment tracheal and bronchial anatomy using the open-source 3D Slicer platform. The method is based on a region growing approach where trachea, right and left bronchi are cropped and segmented independently using three different thresholds. The algorithm and its parameters have been optimized to be efficient across different CT scan acquisition parameters. The performance of the proposed method has been evaluated on EXACT’09 cases and local clinical cases as well as on a breathing pig lung phantom using multiple scans and changing parameters. In particular, to investigate multiple scan parameters reconstruction kernel, radiation dose and slice thickness have been considered. Volume, branch count, branch length and leakage presence have been evaluated. A new method for leakage evaluation has been developed and correlation between segmentation metrics and CT acquisition parameters has been considered.ResultsAll the considered cases have been segmented successfully with good results in terms of leakage presence. Results on clinical data are comparable to other teams’ methods, as obtained by evaluation against the EXACT09 challenge, whereas results obtained from the phantom prove the reliability of the method across multiple CT platforms and acquisition parameters. As expected, slice thickness is the parameter affecting the results the most, whereas reconstruction kernel and radiation dose seem not to particularly affect airway segmentation.ConclusionThe system represents the first open-source airway segmentation platform. The quantitative evaluation approach presented represents the first repeatable system evaluation tool for like-for-like comparison between different airway segmentation platforms. Results suggest that the algorithm can be considered stable across multiple CT platforms and acquisition parameters and can be considered as a starting point for the development of a complete airway segmentation algorithm.

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Background Patients with non-small cell lung cancer (NSCLC) being evaluated for Stereotactic Ablative Body Radiation (SABR) are typically staged non-invasively with positron emission tomography/computed tomography (PET/CT). Incorporating endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) into the staging workup of these patients has not been evaluated. Our primary objective was to compare the performance of PET/CT with EBUS-TBNA for intra-thoracic nodal assessment among SABR-eligible patients. Methods This was a retrospective study consisting of two parts. First, we assessed the concordance for nodal metastasis of PET/CT and EBUS-TBNA. Secondly, we evaluated clinical outcomes among patients who underwent SABR with and without a prior EBUS-TBNA. Results We identified 246 eligible patients. Compared with PET/CT, EBUS-TBNA led to a stage shift in 48 of 246 patients (19%). Out of 174 N0 patients by PET/CT, 6 (3.4%) had nodal metastasis on EBUS-TBNA. Among 72 clinical N1 patients, 36 (50%) were downstaged to N0 after EBUS-TBNA, therefore becoming SABR-eligible. Concordance between PET/CT and EBUS-TBNA for nodal metastasis was 83% (kappa 0.53). Clinical outcomes of patients who underwent SABR with or without a prior EBUS-TBNA did not differ significantly. Conclusions Concordance of PET/CT and EBUS-TBNA for nodal disease was only moderate. Incorporating EBUS-TBNA into the staging workup was beneficial in both identifying occult nodal metastasis that would otherwise be left untreated with SABR, and in expanding the pool of potentially SABR-eligible patients.