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Intracavitary pulmonary aspergilloma is a persistent and life-threatening infection that carries a mortality rate of up to 15%. It occurs when Aspergillus species gain entry to an existing lung cavity. In the absence of definitive treatment, patients may succumb to severe complications such as massive hemoptysis, cachexia, or secondary infections. Aspergillomas often show limited response to antifungal medications, mainly due to insufficient drug concentrations within the cavities. Surgery is frequently the preferred treatment option, but it poses significant risks, and many individuals are ineligible due to underlying health issues. We present the most extensive non-surgical fungal ball cohort to date, managed using an innovative multimodal strategy that combines antifungal therapy before and after bronchoscopic debulking. This was a cross-sectional observational study. For those who cannot undergo surgery, our medical center has pioneered a multimodal approach to aspergilloma resection. This approach combines bronchoscopic endoscopy with antifungal therapy and has been applied successfully to more than 18 patients that are presented in this series. The median age of the cohort was 58 years (range: 32–73), with an equal sex distribution. The mean percent predicted FEV1 was 65.3%. The mean follow-up duration was 3.6 years (range: 0.5–10 years). The cohort receiving antifungals systematically prior to debridement showed a reduction of the pre-existing cavity (40.38 mm versus 34.02 mm, p = 0.021). Across the 18 patients during the follow-up period, 94% remained recurrence-free (defined by symptoms and radiology). Our study fills a critical knowledge gap regarding the significance of initiating antifungal treatment before bronchoscopic debulking and presents a viable approach in these cases for which there is a current unmet therapeutic need. Plain Language Summary The use of both medical and interventional methods to treat difficult fungal masses: A collection of cases showing efficacy for patients who can’t undergo surgery Intracavitary pulmonary aspergilloma is a serious and potentially deadly infection with a death rate of up to 15%. It happens when certain types of fungi invade existing lung cavities. Without proper treatment, patients may experience severe complications like heavy bleeding from the lungs, weight loss, or other infections. Traditional antifungal medications often don’t work well because they can’t reach high enough concentrations in the cavities. Surgery is usually the best option, but it’s risky and not possible for many due to other health problems. Our study introduces a new way to treat aspergilloma without surgery. We’ve treated a significant number of patients using a combination of antifungal drugs and a procedure called bronchoscopic debulking. This involves removing the fungal growth using a thin tube inserted through the airways. Our research involved observing 18 patients treated this way. They were mostly middle-aged, with equal numbers of men and women. Their lung function was moderately impaired, and we followed them for an average of 3.6 years. We found that giving antifungal drugs before the debulking procedure helped reduce the size of the cavities. After treatment, almost all patients remained free of symptoms and signs of recurrence. This study highlights the importance of starting antifungal therapy before bronchoscopic debulking and offers a promising option for patients who can’t have surgery.

IntroductionThe Stather Canadian Outcomes registry for chest ProcedurEs (SCOPE registry) is a Canadian multicentre registry of chest procedures.Methods and analysisThe SCOPE registry is designed as a multicentre prospective database of specific bronchoscopic or other pulmonary procedures. Each procedure of interest will be associated with a registry module, and data capture designed to evaluate effectiveness of procedures on relevant patient outcomes. Participating physicians will be asked to enter data for all procedures performed in a given module. The anonymised dataset will be housed in a web-based electronic secure database. Specific modules included will be based on participating physician suggestions, capacity and consensus of the steering committee and relevance of hypotheses/research potential.Ethics and disseminationThe central registry is under approval from the Conjoint Health Research Ethics Board at the University of Calgary. We aim for registry data to lead to publication of manuscripts in international medical journals as the primary mode of dissemination. Data may also be used by local investigators for personal and/or institutional quality control purposes as well as to inform health policies. Data requests from non-participating investigators for use under ethics approved research protocols can be considered.

Sequelae of foreign body aspiration can range from clinically silent and asymptomatic to immediate asphyxiation and death. Only two previous cases of bisphosphonate tablet aspiration have been reported. Ulcerative esophagitis, a known adverse effect of oral bisphosphonate formulations, occurs primarily with prolonged exposure of esophageal mucosa to the medication. Little is known about the effects of bisphosphonates on the airway mucosa. The authors present a case involving an 84‐year‐old woman who required multiple bronchoscopic debridements, intubation for airway protection and intensive care unit admission following airway injury believed to be due to delayed recognition of aspiration of an alendronate tablet.

The last decades of the 20th century witnessed strongly growing interest in evolutionary approaches to the human past. Even now, however, there is little real agreement on what evolutionary archaeology is all about. A major obstacle is the lack of consensus on how to define the basic principles of Darwinian thought in ways that are genuinely relevant to the archaeological sciences. Each chapter in this new collection of specially invited essays focuses on a single major concept and its associated key words, summarizes its historic and current uses, and then reviews case studies illustrating that concept's present and probable future role in research. What these authors say shows the richness and current diversity of thought among those today who insist that Darwinism has a key role to play in archaeology. Each chapter includes definitions of related key words. Because the same key words may have the same or different meanings in different conceptual contexts, many of these key words are addressed in more than one chapter. In addition to exploring key concepts, collectively the book's chapters show the broad range of ideas and opinions in this intellectual arena today. This volume reflects—and clarifies—debate today on the role of Darwinism in modern archaeology, and by doing so, may help shape the directions that future work in archaeology will take.

Using data from two large data sets of lung-cancer screening by CT, the authors identified factors that increased the likelihood that a nodule was malignant, including older age, female sex, nodule location in the upper lobe, lower nodule count, and certain nodule features. The U.S. National Lung Screening Trial showed that screening with the use of low-dose thoracic computed tomography (CT) reduces mortality from lung cancer by 20%. 1 Major clinical issues in the implementation of low-dose CT screening at the population level include the definition of a positive screening result and the appropriate management of lung nodules detected on a scan. More than 20% of participants in low-dose CT screening programs were found on their first scan to have one or more lung nodules that required further investigation. 1 – 4 The proportion of invasive diagnostic procedures ranged from 1 to 4%. 1 , 3 The risk . . .

Results from retrospective studies indicate that selecting individuals for low-dose CT lung cancer screening on the basis of a highly predictive risk model is superior to using criteria similar to those used in the National Lung Screening Trial (NLST; age, pack-year, and smoking quit-time). We designed the Pan-Canadian Early Detection of Lung Cancer (PanCan) study to assess the efficacy of a risk prediction model to select candidates for lung cancer screening, with the aim of determining whether this approach could better detect patients with early, potentially curable, lung cancer. We did this single-arm, prospective study in eight centres across Canada. We recruited participants aged 50–75 years, who had smoked at some point in their life (ever-smokers), and who did not have a self-reported history of lung cancer. Participants had at least a 2% 6-year risk of lung cancer as estimated by the PanCan model, a precursor to the validated PLCOm2012 model. Risk variables in the model were age, smoking duration, pack-years, family history of lung cancer, education level, body-mass index, chest x-ray in the past 3 years, and history of chronic obstructive pulmonary disease. Individuals were screened with low-dose CT at baseline (T0), and at 1 (T1) and 4 (T4) years post-baseline. The primary outcome of the study was incidence of lung cancer. This study is registered with ClinicalTrials.gov, number NCT00751660. 7059 queries came into the study coordinating centre and were screened for PanCan risk. 15 were duplicates, so 7044 participants were considered for enrolment. Between Sept 24, 2008, and Dec 17, 2010, we recruited and enrolled 2537 eligible ever-smokers. After a median follow-up of 5·5 years (IQR 3·2–6·1), 172 lung cancers were diagnosed in 164 individuals (cumulative incidence 0·065 [95% CI 0·055–0·075], incidence rate 138·1 per 10 000 person-years [117·8–160·9]). There were ten interval lung cancers (6% of lung cancers and 6% of individuals with cancer): one diagnosed between T0 and T1, and nine between T1 and T4. Cumulative incidence was significantly higher than that observed in NLST (4·0%; p<0·0001). Compared with 593 (57%) of 1040 lung cancers observed in NLST, 133 (77%) of 172 lung cancers in the PanCan Study were early stage (I or II; p<0·0001). The PanCan model was effective in identifying individuals who were subsequently diagnosed with early, potentially curable, lung cancer. The incidence of cancers detected and the proportion of early stage cancers in the screened population was higher than observed in previous studies. This approach should be considered for adoption in lung cancer screening programmes. Terry Fox Research Institute and Canadian Partnership Against Cancer.