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Stage III N2 nonsmall cell lung cancer (NSCLC) is a complex disease with poor treatment outcomes. For patients in whom the disease is considered technically resectable, the main treatment options include surgery (with neoadjuvant or adjuvant chemotherapy/neoadjuvant chemoradiotherapy (CRT)) or CRT followed by adjuvant immunotherapy (dependent on programmed death ligand 1 status). As there is no clear evidence demonstrating a survival benefit between these options, patient preference plays an important role. A lack of a consensus definition of resectability of N2 disease adds to the complexity of the decision-making process. We compared 10 international guidelines on the treatment of NSCLC to investigate the recommendations on preoperatively diagnosed stage III N2 NSCLC. This comparison simplified the treatment paths to multimodal therapy based on surgery or radiotherapy (RT). We analysed factors relevant to decision-making within these guidelines. Overall, for nonbulky mediastinal lymph node involvement there was no clear preference between surgery and CRT. With increasing extent of mediastinal nodal disease, a tendency towards multimodal treatment based on RT was identified. In multiple scenarios, surgery or RT-based treatments are feasible and patient involvement in decision-making is critical. Copyright ©ERS 2020.Objectives The aim of this study was to establish whether early pulmonary rehabilitation after severe exacerbation of chronic obstructive pulmonary disease (COPD) reduces mortality and hospital admissions, and increases physical performance and quality of life compared to rehabilitation initiated later in the stable phase of COPD. Methods In a randomised controlled trial of 150 patients hospitalised with an exacerbation of COPD, participants were allocated to pulmonary rehabilitation either within 2 weeks after discharge or the same rehabilitation programme but initiated 2 months after discharge. Results Early pulmonary rehabilitation did not prolong time to first hospital admission or time to death (hazard ratio 0.79, 95% CI 0.47-1.23, p=0.33) compared to rehabilitation in stable phase. However, 2 months after inclusion, pulmonary rehabilitation resulted in a significantly better improvement in the incremental shuttle walk test (33.9 m, 95% CI 4.18-63.7, p=0.02) compared to that in the stable phase. The difference in the endurance shuttle walk test was of borderline significance (140 s, 95% CI -2.03-282.76, p=0.05), but there was no significant difference concerning the COPD assessment test (-1.43 points, 95% CI -3.44-0.59, p=0.17). Conclusion Early pulmonary rehabilitation after acute exacerbation of COPD led to a faster improvement in physical performance compared to rehabilitation initiated later in the stable phase, but did not improve survival or prolong time to hospital readmission. Copyright ©ERS 2020.Healthcare service and patient barriers contribute to low referral to and uptake of pulmonary rehabilitation (PR). Solutions should support skilled clinician-patient conversations and span primary care-PR boundaries to prevent disjointed working. http//bit.ly/2PVKHZf. Copyright ©ERS 2020.The European Respiratory Society (ERS) International Congress 2019 in Madrid, Spain, was a platform for scientific discussion of the highest quality scientific research, cutting-edge techniques and innovative new therapies within the respiratory field. This article discusses some of the high-quality research studies presented at that Congress, with a focus on airway diseases, including asthma, COPD, small airways, bronchiectasis and cough, presented through the Airway Diseases, Asthma and COPD Assembly (Assembly 5) of the ERS. The authors establish the key take-home messages of these studies, compare their findings and place them into context of current understanding. Copyright ©ERS 2020.Airways tell a tale measuring change in airway volume using functional respiratory imaging can differentiate between stable and progressive idiopathic pulmonary fibrosis on CT scans #imagebiomarkers #ipf http//bit.ly/2M8KVLl. Copyright ©ERS 2020.Freshwater turtles inhabit most rivers and creeks on the east coast of Australia, but some species are only found in specific catchments, which makes them vulnerable to extinction. During annual fieldtrips to Alligator Creek, North Queensland, the resident population of Myuchelys latisternum and Emydura macquarii krefftii in a natural pond, just outside Bowling Green National Park, have been surveyed for a number of years and demographic data recorded against tagged turtles. Rounded, cutaneous lesions on individual animals were first noted in August 2016, three years after the first survey of the population. Src inhibitor Turtles living in the upstream sections of the creek were not affected. An initial investigation into the cause of the lesions ruled out pollutants and although the bacterial communities appeared to be different on turtles with lesions, a causative agent was not identified. Attempts to isolate virus in culture was not successful and specific PCRs for ranavirus, papillomavirus, adenovirus and herpesvirus dut lesions. Intra-species aggression associated with seasonal behaviours could potentially be the primary cause of skin trauma, followed by a secondary invasion of an unusual pathogen present in the environment. Copyright © 2020 Wirth, Elliott, Rudd, Hayes, Maclaine, Mashkour, Ahasan, Gorm Dahl, Drane and Ariel.Introduction Canine interverterbral disc (IVD), although physiologically acellular, displays an inflammatory cell population consisting almost exclusively of macrophages (Mϕ) when acutely herniated. Mϕ encompass a heterogenous cell population, roughly divided into classically (M1) or alternatively activated (M2)Mϕ. Polarization into M1 Mϕ leads to strong antimicrobial activity and pro-inflammatory response. In contrast, M2Mϕ exibit anti-inflammatory function and regulate wound healing. link2 The purpose of this study was to characterize the phenotype of the Mϕ population present in naturally occurring IVD herniation. Materials and Methods IVD material of dogs with IVD disease was collected during standard decompressive surgery. A negative control consisting of IVD material of dogs without IVD degeneration and a positive control consisting of canine liver and lymph node samples were also included. link3 All samples were embedded in OCT and shock frozen. Eight micrometer cryostat sections were prepared, air dried and immunostained without prefixation or permeabilization. CD14 was used as marker Mϕ, MHCII for M1Mϕ and CD206 for M2Mϕ. Results Fifteen samples of dogs with IVD herniation, 10 negative, and 5 positive control samples were obtained. No positive cell was found in the negative control group. The positive control group displayed several MHCII and CD206 positive cells, all of them being simultaneously positive to CD14. All herniated samples displayed a mixed population of M1Mϕ and M2Mϕ, and some sparse Mϕ displaying markers for both M1 and M2Mϕ simultaneously. Conclusion The mixed phenotype encountered shows the plasticity and dynamism of Mϕ and evidences the chronic component of IVD disease despite its acute clinical presentation. Copyright © 2020 Vizcaíno Revés, Mogel, Stoffel, Summerfield and Forterre.Cryptosporidium spp., Giardia spp. and microsporidia are important intestinal protozoa responsible for diarrhea in humans and other mammals. China is a major chicken-raising country, and studies on these protozoa in chickens have important public health significance. Here, we investigated the prevalence and genetic characterization of these parasites in chickens from Ezhou City, Hubei Province, China. In total, 206 stool specimens were collected from chickens in four villages of Ezhou between July 2014 and February 2015. Genomic DNA of each specimen was tested by nested PCR based on the Cryptosporidium small subunit rRNA gene, the Giardia intestinalis triose phosphate isomerase gene, and the internal transcribed spacer of the Enterocytozoon bieneusi rRNA gene, respectively. The public health significance of G. intestinalis and E. bieneusi identified in our study was evaluated via phylogenetic analysis. The infection rates were determined to be 2.43% (5/206), 8.25% (17/206), and 1.94% (4/206) for Cryptosporidium, G. intestinalis, and E. bieneusi, respectively. One sample showed coinfection with G. intestinalis and E. bieneusi. Meanwhile, sequence analysis of the PCR-positive samples showed that the Cryptosporidium was C. baileyi, G. intestinalis was assemblage C, and E. bieneusi was genotype D and novel genotype EZ0008. This is the first report of zoonotic G. intestinalis assemblage C in chickens in the world, and the first report of zoonotic E. bieneusi genotype D in chickens in China. These findings indicate new transmission dynamics and molecular epizootiology. Copyright © 2020 Cao, Xu, Jiang, Liu, Yuan, Sun, Cao and Shen.A 10-year old, castrated male, Bichon Frise with a history of hyperadrenocorticism and intrahepatic portal vein hypoplasia was diagnosed with superficial necrolytic dermatitis (SND). The dog exhibited thick crusts on the chin, muzzle, prepuce, and paws. In addition, the dorsal surfaces of all paws were erythematous while the palmar/plantar surfaces were hyperkeratotic, hardened, and painful. The dog was treated with intravenous amino acid infusions (AAI), raw egg yolks, as well as zinc and omega-3 fatty acid oral supplements. The dog required AAI once every 2-3 weeks because this coincided with recrudescence of painful skin lesions. The dog was subsequently diagnosed with diabetes mellitus. A consult with the Nutrition Service was pursued 220 days after the original SND diagnosis because of concern for feeding raw eggs and for malnutrition since appetite was variable, muscle condition was reduced, and greater than 50% of ingested calories were from foods that were not nutritionally complete. There was also could substantially increase time interval between AAI and outcome in dogs with SND. Copyright © 2020 Jaffey, Backus, Sprinkle, Ruggiero, Ferguson and Shumway.The genus Exophiala is composed of ubiquitous, pigmented, saprotrophic fungi and includes both terrestrial and waterborne species. Though Exophiala species are generally considered opportunistic pathogens, exophialosis can be an important cause of morbidity and mortality in aquatic and semi-aquatic species. Over a 6-year period, a captive 32-year-old male eastern hellbender (Cryptobranchus alleganiensis alleganiensis), was treated for recurring, slow growing, ventral midline cutaneous masses. Excisional biopsies were characterized histologically by granulomatous dermatitis with low numbers of intralesional, pigmented fungal conidia and hyphae. Bacterial and fungal cultures of the masses and skin were negative on two separate submissions. Polymerase chain reaction amplification of a short fragment of the fungal 28S large subunit (LSU) ribosomal RNA was positive with 100% nucleotide sequence identity to several species of Exophiala. Following recurrence after successive rounds of antifungal therapy, euthanasia was elected. At necropsy, similar dermal granulomatous inflammation and intralesional pigmented fungal elements as observed in excisional biopsies formed a thick band in the dermis and extended through the coelomic body wall. Visceral dissemination was noted in the lung and kidney. Postmortem DNA sequence analysis of a large portion of the fungal LSU as well as the internal transcribed spacer (ITS) from a portion of frozen affected dermis identified the fungus as a novel species, Exophiala sp. 1 (UTHSCSA R-5437). Copyright © 2020 Hopf, Graham, Gibas, Sanders, Mele, Fan, Garner, Wiederhold, Ossiboff and Abou-Madi.