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BackgroundLung cancer outcomes in the UK are worse than in many other developed nations. Symptom awareness campaigns aim to diagnose patients at an earlier stage to improve cancer outcomes.MethodsAn early diagnosis campaign for lung cancer commenced in Leeds, UK in 2011 comprising public and primary-care facing components. Rates of community referral for chest X-ray and lung cancer stage (TNM seventh edition) at presentation were collected from 2008 to 2015. Linear trends were assessed by χ2 test for trend in proportions. Headline figures are presented for the 3 years pre-campaign (2008–2010) and the three most recent years for which data are available during the campaign (2013–2015).FindingsCommunity-ordered chest X-ray rates per year increased from 18 909 in 2008–2010 to 34 194 in 2013–2015 (80.8% increase). A significant stage shift towards earlier stage lung cancer was seen (χ2(1)=32.2, pInterpretationThis is the largest described lung cancer stage-shift in association with a symptom awareness campaign. A causal link between the campaign and stage-shift cannot be proven but appears plausible. Limitations of the analysis include a lack of contemporary control population.

ObjectiveTo evaluate rituximab (RTX) in patients with RA-associated bronchiectasis (RA-BR) and compare 5-year respiratory survival between those treated with RTX and TNF inhibitors (TNFi).MethodsA retrospective observational cohort study of RA-BR in RTX or TNFi-treated RA patients from two UK centres over 10 years. BR was assessed using number of infective exacerbation/year. Respiratory survival was measured from therapy initiation to discontinuation either due to lung exacerbation or lung-related deaths.ResultsOf 800 RTX-treated RA patients, 68 had RA-BR (prevalence 8.5%). Post-RTX, new BR was diagnosed in 3/735 patients (incidence 0.4%). At 12 months post-Cycle 1 RTX, 21/68 (31%) patients had fewer exacerbations than the year pre-RTX, 36/68 (53%) remained stable and 11/68 (16%) had increased exacerbations. The rates of exacerbation improved after Cycle 2 and stabilized up to 5 cycles. Of patients who received ≥2 RTX cycles (n = 60), increased exacerbations occurred in 7/60 (12%) and were associated with low IgG, aspergillosis and concurrent alpha-1-antitrypsin deficiency. Overall, 8/68 (11.8%) patients discontinued RTX while 15/46 (32.6%) discontinued TNFi due to respiratory causes. The adjusted 5-year respiratory survival was better in RTX-treated compared with TNFi-treated RA-BR patients; HR 0.40 (95% CI 0.17, 0.96); P =0.041.ConclusionThe majority of RTX-treated RA-BR patients had stable/improved pulmonary symptoms in this long-term follow-up. In isolated cases, worsening of exacerbation had definable causes. Rates of discontinuation due to adverse lung outcomes were better for RTX than a matched TNFi cohort. RTX is an acceptable therapeutic choice for RA-BR if a biologic is needed.

Background: Radiological monitoring of malignant pleural mesothelioma (MPM) using modified RECIST criteria is limited by low sensitivity and inter-observer variability. Serial serum mesothelin measurement has shown utility in the assessment of treatment response during chemotherapy but has never been assessed in the longer term follow up of patients.Methods: This is a single centre study of consecutive patients diagnosed with MPM who received chemotherapy or best supportive care (BSC). Serum mesothelin measurements with paired 6 monthly CT scans were performed following the completion of chemotherapy, or from baseline in the BSC group. Changes in mesothelin were correlated with radiological progression and overall survival.Results: Forty-one patients with MPM were recruited and followed up for a minimum of 12 months (range 12-21 months). The majority of patients (n=23) received chemotherapy with pemetrexed and cisplatin. Across the cohort a 10% rise in serum mesothelin could predict radiological progression with a sensitivity of 96% (IQR; 79-100) and specificity of 74% (IQR; 50-91). Sensitivity fell to 80% in sarcomatoid only disease. Patients with a rising mesothelin at 6 months had significantly worse overall survival (175 days) compared to stable/falling levels (448 days) (p=0.003).Conclusions: This is the first study to assess serum mesothelin’s ability to detect progression of MPM following chemotherapy or during BSC. A 10% rise in serum mesothelin level showed excellent sensitivity at predicting progressive disease. Mesothelin measurement has several advantages over serial CT imaging including reducing hospital visits and cost.

Purpose The purpose of this study was to compare the use of fluorine-18-fluorodeoxyglucose (18F-FDG) PET with computed tomography (CT) and dynamic contrast-enhanced (DCE) MRI to predict prognosis and monitor treatment in malignant pleural mesothelioma. Patients and methods 18F-FDG PET/CT and DCE-MRI studies carried out as part of the South West Area Mesothelioma Pemetrexed trial were used. 18F-FDG PET/CT and DCE-MRI studies were carried out before treatment, and after two cycles of chemotherapy, on patients treated with pemetrexed and cisplatin. A total of 73 patients were recruited, of whom 65 had PET/CT and DCE-MRI scans. Baseline measurements from 18F-FDG PET/CT (maximum standardized uptake value, metabolic tumour volume and total lesion glycolysis) and DCE-MRI (integrated area under the first 90s of the curve and washout slope) were compared with overall survival (OS) using Kaplan–Meier and Cox regression analyses, and changes in imaging measurements were compared with disease progression. Results PET/CT and DCE-MRI measurements were not correlated with each other. Maximum standardized uptake value, metabolic tumour volume and total lesion glycolysis were significantly related to OS with Cox regression analysis and Kaplan–Meir analysis, and DCE-MRI washout curve shape was significantly related to OS. DCE-MRI curve shape can be combined with 18F-FDG PET/CT to give additional prognostic information. Changes in measurements were not related to progression-free survival. Conclusions 18F-FDG PET/CT and DCE-MRI give prognostic information in malignant pleural mesothelioma. Neither PET/CT nor DCE-MRI is useful for monitoring disease progression.

Objective. To evaluate the effect of rituximab (RTX) in patients with RA-related interstitial lung disease (RA-ILD) and identify factors associated with outcome after treatment. Methods. An observational study of patients with RA-ILD was conducted from a cohort of RTX-treated RA patients in a single centre for >10 years. Progression was defined by any of the following: a decrease of pre-RTX forced vital capacity (FVC) >10% or diffusion capacity of carbon monoxide (DLCO) >15% predicted, worsening of the ILD score or death from progressive ILD. Results. Of 700 RA patients treated with RTX, 56 had RA-ILD (prevalence = 8%). After RTX, new ILD was diagnosed in 3/700 patients (incidence = 0.4%). Data for lung assessment were available for 44/56 patients. The median relative change pre- and post-RTX for FVC were −2.4% and +1.2% (P = 0.025) and for DLCO were −4.4% and −1.3% (P = 0.045). Post-RTX, 23/44 (52%) were stable and 7/44 (16%) had improved. Of the 14 (32%) with ILD that progressed, 9/56 (16%) were deaths due to progressive ILD. Factors associated with ILD progression were radiologic pattern of usual interstitial pneumonia, a previous history of lung progression and pre-RTX DLCO

OBJECTIVE: Diffuse pleural thickening (DPT) refers to extensive visceral pleural fibrosis with adhesion formation to the parietal pleura obliterating the pleural space. The radiological definition of DPT remains controversial with most of the literature requiring the presence of an obliterated costophrenic angle (CPA) for defining DPT. We conducted a study to investigate the variable distributions of DPT and associated lung function deficit. METHODS: 85 patients referred to a pleural clinic with suspected pleural thickening were screened for our study. Data were collected from 37 patients with DPT confirmed on CT by size criteria (≥3 mm thick, ≥5 cm wide and ≥8 cm in length), and 21 controls with pleural plaques but no other pleuroparenchymal pathology. 27 patients were excluded. Groups were matched to age, body mass index and smoking history. RESULTS: The percentage of predicted forced vital capacity showed a gradual decline from 98.9% for the control group to 83.5% in the DPT without CPA obliteration group (p < 0.05), to 79.5% in the unilateral DPT group (p < 0.001) and 66.7% in the bilateral group (p < 0.001). Similar reductions were seen in the percentage of predicted total lung capacity in the DPT with no CPA obliteration group and the bilateral DPT group. CONCLUSION: Our study shows an incremental reduction in the forced vital capacity and total lung capacity in DPT without CPA obliteration, unilateral and bilateral DPT when compared with a matched control group. ADVANCES IN KNOWLEDGE: Different distributions of DPT including no CPA obliteration can cause respiratory impairment, with bilateral DPT being the worst affected.

Chaska, a new monotypic genus of Acrotrichinae, Acrotrichini with its single species nawi is described and figured. Superficially similar to the more rounded species of Acrotrichis but distinguished by ventral characters in particular the form of the mesoventral collar and the rounded pronotal hind angles. The insect was collected by Dr Caroline Chaboo and her students at the University of Kansas as part of an inventory of leaf beetles in Peru. The name chosen as the winning entry in a national competition to name a beetle species and raise awareness about cryptic biodiversity.

Peruvium a new subgenus of Ptenidium Erichson with seven new species: P. brevissimum sp. n.; P. carinatum sp. n.; P. capillatum sp. n.; P. contractum sp. n.; P. gibbosum sp. n.; P. inornatum sp. n. and P. grande sp. n. is described and figured. The insects were collected by Dr Caroline Chaboo and her students at the University of Kansas as part of a programme to compile an inventory of leaf beetles in Peru and are the first records of Ptenidium from the country. A key is provided.

BackgroundThe use of imaging that employs ionising radiation is increasing in the setting of paediatric cardiology. Children's high radiosensitivity and the lack of contemporary radiation data warrant a review of the radiation doses from the latest “state-of-the-art” angiography and computed tomography systems.ObjectivesIn children aged less than 16 years with congenital cardiac disease, we aimed to report: recent trends in the use of diagnostic angiography and cardiac dual-source computed tomography; the characteristics, lesions, and imaging histories of patients undergoing these procedures; and the average radiation doses imparted by each modality.Study designRetrospective review of consecutive cases undergoing cardiac computed tomography or diagnostic angiography in a teaching hospital between January, 2008 and December, 2009. Radiation doses were converted to effective doses (millisievert) using published conversion factors.ResultsAngiography was performed 3.7 times more often than computed tomography. Computed tomography examinations increased by 92.5%, whereas angiography decreased by 26.4% in 2009 compared with 2008. Patients undergoing computed tomography were younger and weighed less than those undergoing angiography, but lesions were similar between the 2 groups. Multiple lifetime angiography was more prevalent than multiple lifetime computed tomography (p < 0.001). The median procedural dose – range – from angiography and computed tomography was 5 (0.2–27.8) and 1.7 (0.5–9.5) millisieverts, respectively (p < 0.001).ConclusionDespite not being completely analogous investigations, computed tomography should be considered prior to angiography and not withheld on radiation dose concerns, given that it imparts lower and more consistent doses than conventional angiography.

Phytotelmatrichis, gen. n. a new genus of Ptiliidae: Acrotrichinae with two species Phytotelmatrichis peruviensis sp. n. and Phytotelmatrichis osopaddington sp. n. is described and illustrated. The new species were found during a survey of insects in the aquatic environments that form in the hollows (phytotelmata) in the leaves and floral bracts of Zingiberales plants. The new taxa were found in the the Zingiberales genera Calathea (Marantaceae), Heliconia (Heliconiaceae), and Alpinia and Renealmia (Zingiberaceae) in southern Peru. Sampling of other habitats in the same areas over five years and using a range of different techniques did not yield more specimens of this new genus. This suggests that the new species are restricted to phytotelmata.

This is the third report on a collection of Ptiliidae from Bolivian forest leaf litter made by Dr Petr Baňař of the Brno Museum (Czech Republic) in 2013. A new species Nossidium katyae, is described and figured on the basis of a single specimen collected in the Amboro National Park. Comparative figures of Nossidium pilosellum Marsham are provided together with a brief synopsis of views on the desirability of establishing a new subfamily within the Ptiliidae to include Nossidium group species.

This is the first report detailing Ptiliidae collected from forest leaf litter by the Moravian Museum expeditions to Madagascar 2010-2011.18 new species in three genera are described and figured: Discheramocephalus bisulcatus sp. n.; D. vasilii sp. n.; Cissidium banari sp. n.; Dacrysoma andasibense sp. n.; D. imitatuin sp. n.; D. delicatum sp. n.; D. denticulatum sp. n.; D. dolorosum sp. n.; D. fabrum sp. n.; D. fusum sp. n.; D. longulum sp. n.; D. nigerrimum sp. n.; D. pilosum sp. n.; D. rahanitriniainae sp. n.; D. ranomafanense sp. n.; D. ravelosoni sp. n.; D. subinsulsum sp. n.; and D. varium sp. n.

This is the second report on a collection of Ptiliidae from Bolivian forest leaf litter made by Dr Petr Baňař of the Brno Museum (Czech Republic) in 2013. A small collection of Bolivian Acrotrichis in the Natural Museum, London, made by H. Mendel and M.V.L. Barclay in 2004 is also included. Two new monotypic genera are described Petrotrichis gen. n. (Acrotrichini), type species P. rotundata sp. n., and Microtrichis gen. n. (Nephanini), type species M. pectana sp. n., together with eight new species of Acrotrichis: A. armillata sp. n., A. cincinna sp. n., A. cornuta sp. n., A. corpulenta sp. n., A. inlecebrosa sp. n., A. linea sp. n., A. nashi sp. n. and A. segmenta sp. n..

This is the first report on a collection of Ptiliidae from Bolivian forest leaf litter made by Dr Petr Baňař of the Brno Museum (Czech Republic). Six new species in the genus Cissidium Motschulsky, are described and figured: C. amboroensis, sp. n., C. globosum, sp. n., C. elongatum, sp. n., C. lisae sp. n., C. petri sp. n. and C. tigrum, sp. n.. The relationship of Cissidium to Dacrysoma Grebennikov and its position in the tribe Discheramocephalini is discussed, and the generic description revised so as to encompass all valid species.

This is the fourth report detailing Ptiliidae collected from forest litter by the Moravian Museum (Brno, Czech Republic) expeditions to Madagascar 2010-2013. Eight new species are described and figured: B. edwardi sp. n.; B. lanquidula sp. n.; B. merina sp.n.; B. opaca sp. n.; B. problematica sp. n.; B. secubita sp. n.; B. thomasi sp. n. and B. verecunda sp. n., and new data recorded for B. dybasi Johnson. Problems concerning the genital morphology and species determination of the parthenogenetic members of the genus are discussed in relation to the findings, and the first blind and apterous species reported.A key to the known species from the island is provided.

This is the third report detailing Ptiliidae collected from forest leaf litter by the Moravian Museum (Brno, Czech Republic) expeditions to Madagascar 2010-2013. After completion of the first draft, which identified 16 new species, more Madagsacan Acrotrichis, collected at earlier dates, were found in the Natural History Museum in London (BMNH). These included 17 unpublished new species determined by Colin Johnson in 1969, 7 of which proved to be the same as those in the Czech material. The decision was taken, therefore, to broaden the scope of the report to include all the mounted Madagascan material in the Museum and to use Johnson's ms names to avoid potential future confusion. 27 new species are described and figured: Acrotrichis absona sp. n.; A. barclayi sp. n.; A. bibula sp. n.; A. boothi sp. n.; A. clareae sp. n.; A. colini sp. n.; A. cuspida sp. n.; A. difficilis sp. n.; A. exigua sp. n.; A. hammondi sp. n.; A. heissi sp. n.; A. hova sp. n.; A. impressa sp. n.; A. lacrimosa sp. n.; A. lauta sp. n.; A. loganovi sp. n.; A. magnifica sp. n.; A. malitiosa sp. n.; A. obscura sp. n.; A. perexigua sp. n.; A. perfida sp. n.; A. strenua sp. n.; A. subafricana sp. n.; A. tampoketsae sp. n.; A. terminalis sp. n.; A. truncata sp. n. and A. tuberosa sp. n., and new data recorded for six others: a. africana Johnson, A. africanoides Johnson, A. cursitans (Nietner), A. discoloroides Johnson, A. minuscula Johnson, and A. superbioides Johnson. New criteria for assessing speciation in Acrotrichis are suggested, the definition of subgenera discussed and a key to all the known species from the island provided.

This is the second report detailing Ptiliidae collected from forest leaf litter by the Moravian Museum expeditions to Madagascar 2010-2012. 3 new species are described and figured: Ptenidium azafady sp. n., P. lambdai sp. n., and P. tanalai sp.n., and the criteria for assessing subgeneric status discussed.

This paper describes a new genus and species of Acrotrichinae, Seminis factiosum gen. n., sp. n.; two new species of Nossidium : Nossidium schuelkei , n. sp. and Nossidium issyae , sp. n.; and a new species of Ptenidium ( Peruvium ), Ptenidium gruenbergae sp. n. from Costa Rica. Three further species: Ptenidium nitidum (Heer), Petrotrichis rotundata Darby, and Bambara invisibilis Nietner are recorded as being present. With the exception of N. issyae all the insects were collected using a vehicle roof–mounted net on a single 40 kilometre drive from the east and west coasts of the Osa Peninsula by M. Schulke and B. Grunberg in 2012.

Aim: To test the safety of intravenous contrast in patients with renal insufficiency undergoing computed tomography compared with a concurrent group of patients who received no contrast. Materials and Methods: Between October 2006 and February 2007, 106 consecutive patients with renal insufficiency who underwent intravenous contrast computed tomography were retrospectively reviewed. A separate group of 52 patients with renal insufficiency who did not receive intravenous contrast was also reviewed and acted as control group. Baseline and repeat creatinine (in micromole per liter) and estimated glomerular filtration rate (eGFR) levels were obtained for all patients using the modification of diet in renal disease equation within 3.5 days. Mann-Whitney U test was used to determine any statistically significant changes in creatinine and eGFR values. Subgroup analysis involving only patients with eGFR values of less than 60 was also performed. Results: The mean creatinine before and after contrast was 135.45 and 151.37, respectively (P = 0.724). The mean eGFR before and after contrast was 44.33 and 43.41, respectively (P = 0.824). Subgroup analysis of 63 patients involving patients with eGFR of less than 60 revealed precontrast and postcontrast creatinine mean to be 136.21 and 158.40, respectively (P = 0.248). Estimated GFR mean values in the same group before and after contrast were 43.71 and 40.70, respectively (P = 0.250). Control group showed precontrast and postcontrast eGFR (and creatinine) mean values to be 40 (162.04) and 38 (168.52), respectively (P = 0.641). Conclusions: Estimated GFR (and creatinine) values in patients with renal insufficiency did not show a statistically significant increase after a mean of 3.5 days of receiving intravenous contrast and therefore supports a conservative outpatient-based management approach.

Computed tomography (CT) is the imaging technique of choice for characterizing pleural masses with respect to their location, composition, and extent. CT also provides important information regarding invasion of the chest wall and surrounding structures. A spectrum of tumours can affect the pleura of which metastatic adenocarcinoma is the commonest cause of malignant pleural disease, while malignant mesothelioma is the most common primary pleural tumour. Certain CT features help differentiate benign from malignant processes. This pictorial review highlights the salient CT appearances of a range of tumours that may affect the pleura.

The recommended depth for chest compression during adult cardiopulmonary resuscitation (CPR) is 4-5 cm, and for children one-third the anterior-posterior (AP) chest diameter. A compression depth of one-third of the AP chest diameter has also been suggested for adult CPR. We have assessed chest CT scans to measure what proportion of the adult AP chest diameter is compressed during CPR. Measurements of AP diameter of chest CT scans were taken from the skin anteriorly at the middle of the lower half of the sternum, perpendicularly to the skin on the posterior thorax. The anatomical structure that would be compressed at this level was also noted. One hundred consecutive CT scans were examined (66 males and 34 females). The age (mean +/- S.D.) was 68+/-12 years. AP chest diameter was 253 +/- 27 mm for males and 235 +/- 30 mm for females. The proportion of total AP chest diameter compressed with current compressions is 15.8-19.8% for males and 17.0-21.3% for females. The commonest anatomical structures that would be compressed are the ascending aorta (38%) and the top of the left atrium (36%). There is also a wide anatomical variation in the shape of the adult chest. A chest compression depth of 4-5 cm in adults equates to approximately one-fifth of the AP diameter of the adult chest.

Female hamster vaginal discharge (FHVD) contains a presumptive pheromone(s) that affects male hamsters in at least 2 ways. Alone it attracts investigatory interest, and if applied to an appropriate stimulus object, it facilitates copulatory behavior. The latter property was investigated by applying a fixed quantity of the discharge to a series of "surrogate females." The results indicated that the patterning and vigor of the elicited behavior more closely resemble the normal stereotyped mating sequence as the features of the stimulus object more closely approach those of a receptive female hamster. The ability of FHVD to facilitate mating with an otherwise sexually uninteresting stimulus object was unchanged 2 wk. after ovariectomy of the donor female.