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Polyacrylonitrile is one of the few waterproof polymers that can be spun from relatively safe solvents, facilitating the use of PAN nanofibers membranes in medical, filtration and biological applications. In this study PAN nanofiber membranes containing SBA-15 nanoparticles were prepared by the process of electrospinning in needless electrospinning machine and DMSO was used as solvent. A small amount of dispersing agent BYK W-9010 was added for a better deagglomerating of SBA-15 nanoparticles in the PAN/DMSO solution. The influence of rod like SBA-15 type ordered mesoporous silica particles as filler on the morphology and textural parameters of electrospun PAN nanofibers was studied. The effect of concentration, applied voltage, distance and feed rate on nanofibers diameter was investigated. The results obtained demonstrated that by increasing the concentration, applied voltage and feed rate, the number of nanofibers was increased and thicker nanofibers were obtained. Viscosity increased by increasing the concentration of polymer and it increased further by imparting small amount of silica nanoparticles. The SEM images of nanofibers were taken and their morphology explains that presence of silica nanoparticles in the nanofibers increases the specific surface area and makes the surface rough.

Human enteric viruses constitute a public health concern due to their low infectious dose and their resistance to environmental factors and to inactivation processes. We aimed at assessing the performance of a laboratory scale Submerged membrane bioreactor (SMBR) treating abattoir wastewaters for Rotavirus (RV) and total coliphages removal. We also aimed at evaluating removal efficiency of enteric viruses through conventional activated sludge treatment by measuring concentrations of total coliphages, considered as fecal and viral contamination indicators, with double-layer agar technique. The Log10 reduction values of bacteriophages ranged from 1.06 to 1.47. Effluents were analyzed to investigate and quantify RV, hepatitis A virus (HAV), Hepatitis E virus (HEV), Noroviruses genogroup I (NoV GI) and genogroup II (NoVGII), and Enterovirus (EV) by real-time PCR, using standardized detection kits (ceeramTools detection kits(®)). All effluent samples were positive for RV; concentrations ranged from 5.2 × 10(5) to 1.3 × 10(7) genome copies/L. These results highlight the inefficiency of conventional biological process for viral removal. A complete removal of RV during Membrane Bioreactor treatment was obtained. To the best of our knowledge, this is the first study providing an evidence of removal of RV simultaneously with total coliphages by SMBR.

Using dual mesoporous titania as a support, due to the presence of intrinsic Brönsted acid sites, the main approach to 4,6-dimethylbenzothiophene (46DMDBT) hydrodesulfurization (HDS) becomes the direct desulfurization (DDS) route through isomerization and dismutation reactions, instead of the hydrogenation (HYD) pathway usually observed with a conventional promoted (by Ni or Co) MoS

International audience; BackgroundChemotherapy combined with radiotherapy is the standard treatment of “limited-stage” small-cell lung cancer. However, controversy persists over the optimal timing of thoracic radiotherapy and chemotherapy.Material and methodsWe performed a meta-analysis of individual patient data in randomised trials comparing earlier versus later radiotherapy, or shorter vs. longer radiotherapy duration, as defined in each trial. We combined the results from trials using the stratified log-rank test to calculate pooled hazard ratios (HRs). The primary outcome was overall survival.ResultsTwelve trials with 2,668 patients were eligible. Data from nine trials comprising 2,305 patients were available for analysis. The median follow-up was 10 years. When all trials were analysed together, “earlier or shorter” vs. “later or longer” thoracic radiotherapy did not affect overall survival. However, the HR for overall survival was significantly in favour of “earlier or shorter” radiotherapy among trials with a similar proportion of patients who were compliant with chemotherapy (defined as having received 100% or more of the planned chemotherapy cycles) in both arms (HR 0.79, 95% CI 0.69–0.91) and in favour of “later or longer” radiotherapy among trials with different chemotherapy compliance (HR 1.19, 1.05–1.34, interaction test p

Recent studies have shown decreased susceptibility of Candida krusei to amphotericin B (AmB), in addition to its inherent resistance to fluconazole. The susceptibility of C. krusei to AmB was studied in the Parasitology-Mycology laboratory of Grenoble Teaching Hospital, France. Between 2003 and 2011, we analysed 200 C. krusei isolates from 130 patients. The isolates were mainly collected in intensive care, cardio-thoracic and cancer/haematology units. Minimum inhibitory concentrations (MICs) were determined by the E-test method. The modal MIC was 0.5 μg ml(-1); the MIC(50) and MIC(90) (MICs encompassing 50% and 90% of all isolates tested, respectively) were 0.5 μg ml(-1) and 1 μg ml(-1). The Cuzick's and Kendall's tests showed a significant increase in MIC values between 2003 and 2011 (P = 0.001 and P ≤ 0.001, respectively), regardless of age or gender. No statistical difference was reached with these tests when the first 100 or 50 data were excluded. Despite the increase observed in the first period of the study, our results confirm the low AmB MICs reported in previous studies. However, some authors have recently reported much higher MICs. This discrepancy cannot be explained by method biases and could reflect C. krusei epidemiological differences among populations.

International audience; A prospective (2005-2007) hospital-based multicentre surveillance of EORTC/MSG-proven or probable invasive aspergillosis (IA) cases whatever the underlying diseases was implemented in 12 French academic hospitals. Admissions per hospital and transplantation procedures were obtained. Cox regression models were used to determine risk factors associated with the 12-week overall mortality. With 424 case-patients included, the median incidence/hospital was 0.271/10(3) admissions (range 0.072-0.910) without significant alteration of incidence and seasonality over time. Among the 393 adults (62% men, 56 years (16-84 years)), 15% had proven IA, 78% haematological conditions, and 92.9% had lung involvement. Acute leukaemia (34.6%) and allogeneic stem cell transplantation (21.4%) were major host factors, together with chronic lymphoproliferative disorders (21.6%), which emerged as a new high-risk group. The other risk host factors consisted of solid organ transplantation (8.7%), solid tumours (4.3%), systemic inflammatory diseases (4.6%) and chronic respiratory diseases (2.3%). Serum galactomannan tests were more often positive (≥69%) for acute leukaemia and allogeneic stem cell transplantation than for the others (

Foodborne viruses, especially noroviruses (NoV), are increasingly reported as the cause of foodborne outbreaks. NoV outbreaks have been reported linked to fresh soft red fruits and leafy greens. Belgium, Canada and France were the first countries to provide data about the prevalence of NoV on fresh produce. In total, 867 samples of leafy greens, 180 samples of fresh soft red fruits and 57 samples of other types of fresh produce (tomatoes, cucumber and fruit salads) were analyzed. Firstly, the NoV detection methodology, including virus and RNA extraction, real-time RT-PCR and quality controls were compared among the three countries. In addition, confirmation and genotyping of the NoV strains was attempted for a subset of NoV positive samples using conventional RT-PCR targeting an alternative region followed by sequencing. Analysis of the process control showed that 653, 179 and 18 samples of the leafy greens, soft red fruits and other fresh produce types were valid for analysis based on the recovery of the process control. NoV was detected by real-time RT-PCR in 28.2% (N=641), 33.3% (N=6) and 50% (N=6) of leafy greens tested in Canada, Belgium and France, respectively. Soft red fruits were found positive by real-time RT-PCR in 34.5% (N=29) and 6.7% (N=150) of the samples tested in Belgium and France, respectively. 55.5% (N=18) of the other fresh produce types, analyzed in Belgium, were found NoV positive by real-time RT-PCR. Conventional RT-PCR resulted in an amplicon of the expected size in 19.5% (52/266) of the NoV positive samples where this assay was attempted. Subsequent sequencing was only successful in 34.6% (18/52) of the suspected amplicons obtained by conventional RT-PCR. From this study, using the described methodology, NoV genomes were frequently detected in fresh produce however sequence confirmation was not successful for the majority of the samples tested. Infection or outbreaks were rarely or not known to be related to the NoV positive samples. With the increase in sensitivity of the detection methodology, there is an increasing concern about the interpretation of positive NoV results by real-time amplification. Strategies to confirm the results by real-time RT-PCR should be developed in analogy with the detection of microbial pathogens in foods. Detection might indicate contact with NoV in the fresh produce chain. Consequently, a potential risk for infection cannot be excluded but the actual risk from RT-PCR NoV positive produce is still unknown. Studies should be designed determining the probability of infection related to the presence or levels of NoV genomic copies.

International audience; The daily number of outdoor spores was counted and the cases of community-acquired invasive aspergillosis (IA) were observed over a period of 31 months. The outdoor fungal load preceding IA occurrences was significantly higher than that measured during IA-free periods, underlining the importance of preventive measures to protect high-risk patients, even at home.

Resume Buts de l’etude Nous nous proposons dans cette etude d’evaluer la contamination par le virus de l’hepatite A (VHA) de coquillages collectes a partir de cinq zones conchylicoles tunisiennes et de rechercher une eventuelle correlation entre la contamination bacterienne et virale. Materiel et methodes Cinquante-quatre echantillons de coquillages ont fait l’objet d’une extraction virale par 2 methodes l’une utilisant l’elution par une solution de glycine et l’autre utilisant une solution d’extrait de bœuf. Les deux methodes ont ete comparees par l’application d’une reverse transcription suivie d’une nested PCR. La recherche de Salmonella et d’ E. coli a ete realisee dans tous les echantillons de coquillages inclus dans cette etude. Resultats Sur les deux techniques testees, la technique a base de glycine a affiche le rendement le plus eleve. Le virus de l’hepatite A a ete detecte dans 32 % des echantillons de coquillages analyses. Les resultats des analyses bacteriologiques ont montre une absence de Salmonella et une contamination par E. coli . Parmi les 17 echantillons de coquillages contamines par le VHA, six echantillons se sont reveles ayant une contamination par E. coli Conclusion Nous avons constate une contamination assez elevee des echantillons de coquillages collectes. Une absence de correlation entre la contamination bacterienne et virale a ete notee.

M. tuberculosis is a possible cause of uveitis; the diagnosis is often difficult. The aim of this study is to evaluate, in this context, the application of an interferon gamma assay, the SpotTB™. The prospective study, in patients presenting with uveitis without obvious cause and not resolving with local treatment, compared the therapeutic approach (giving antituberculous treatment or not) with and without the result of the SpotTB™. The analyses included 23 patients: 78% had received BCG; 78% had isolated ocular involvement; 22% had associated mediastinal lymphadenopathy. The results of the IDR and the SpotTB™ were concordant in 61%, discordant in 22% and non-evaluable in 17% of cases. In the patients with isolated ocular involvement the SpotTB™ avoided treatment in five and reinforced the decision not to treat in 13 others. In the patients with mediastinal lymphadenopathy, the SpotTB™ reinforced the diagnosis of sarcoidosis in four cases (one lost from view). In conclusion, when infection with M. tuberculosis is considered in the aetiology of uveitis the SpotTB™ allows, in a significant number of cases, the avoidance of antituberculous treatment.

Resume Objectifs L'objectif de cette etude etait d'evaluer la pertinence et la conformite des prescriptions des nouveaux antifongiques systemiques en regard des indications validees et des donnees probantes de la litterature scientifique. Patients et methodes Toutes les prescriptions d'amphotericine B liposomale (AmB lip), voriconazole et caspofungine realisees de mai 2003 a mai 2004, dans les services d'un hopital universitaire, ont ete evaluees par un expert en regard de criteres fondes sur l'autorisation de mise sur le marche, les recommandations nationales et les donnees scientifiques actuelles. Resultats Pendant les 12 mois de l'etude, 115 patients ont beneficie de 203 prescriptions d'antifongiques systemiques. La plupart de ces patients etaient immunodeprimes. L'indication d'un traitement antifongique et le choix de la molecule ont ete juges pertinents pour 127 prescriptions (62,6 %). Une cause importante de non-pertinence relevait de l'utilisation d'associations d'antifongiques systemiques (16,3 %). La posologie, la voie d'administration et le respect des interactions medicamenteuses ont ete juges conformes pour 158 prescriptions (77,8 %). Les prescriptions d'AmB lip etaient plus souvent correctes (69,7 %) que celles du voriconazole (60,6 %) ou de la caspofungine (36,8 %) [p Conclusion Ces resultats incitent a mettre en place une politique d'optimisation de l'utilisation des nouveaux antifongiques dans notre etablissement.

Resume Introduction Malgre leur chimiosensibilite initiale, 90 % des cancers bronchiques a petites cellules( CPC) necessitent un traitement de deuxieme ligne, du fait d’une non-reponse a la premiere ligne, d’une progression apres reponse partielle (RP) ou d’une recidive apres reponse complete (RC). Etat des connaissances Le pronostic est alors constamment fatal. Cependant, sauf etat general massivement altere, une chimiotherapie de deuxieme ligne est indiquee, puisqu’elle fournit des taux de reponse atteignant 70 % des cas en recidive apres RC, par reprise du protocole prescrit en premiere ligne lorsque la periode sans recidive et sans traitement est superieure a trois mois. Ces taux sont encore de 20 a 30 % en cas de resistance au traitement initial, avec utilisation de drogues distinctes de celles utilisees en premiere ligne. Topotecan, irinotecan, gemcitabine et lomustine sont surtout utilises. La radiotherapie, thoracique ou cephalique, conserve des indications palliatives. Perspectives Une recherche est en cours pour ameliorer la qualite de vie, notamment par utilisation d’un traitement oral. Un essai randomise teste actuellement l’association lomustine-cyclophosphamide-etoposide, possible source de survies confortables et prolongees. Conclusion La poursuite d’essais collaboratifs reste hautement souhaitable pour repondre a cette question non encore resolue.

A multidisciplinary working group devoted to epidemiological surveillance of invasive aspergillosis (IA) was created in January 2000 in Grenoble University Hospital. This article presents the results of a three-year IA surveillance. The multidisciplinary working group surveyed all hospitalized patients, and the mycology laboratory detected most suspected IA cases. Cases were reviewed monthly by the Aspergillosis Committee, and were classified according to international consensus criteria. Possible nosocomial acquisition was determined. Among the 490 alerts, 74 IA cases were observed: six proven cases (8%), 36 (49%) probable cases and 32 (43%) possible cases. The incidence was 4.4 (95% CI 3.4-5.4) IA/100 000 patient-days. Among the proven and probable IA cases, we observed 10 nosocomial cases and six cases of undetermined origin. No cases were noted in the protected rooms in the haematology unit. Only one cluster of cases (three nosocomial cases) was detected in the haematology unit. Forty-three percent of cases (N=32) were hospitalized in the haematology unit, and all other cases were hospitalized elsewhere. This three-year survey found a high rate of non-nosocomial IA cases and a high frequency of IA cases hospitalized in units other than haematology. Thus, this study shows the importance of IA surveillance in haematology units and all high-risk units.

Purpose: To report a retrospective study concerning the impact of fused 18F-fluoro-deoxy- d -glucose (FDG)-hybrid positron emission tomography (PET) and CT images on three-dimensional conformal radiotherapy planning for patients with non–small-cell lung cancer. Methods and Materials: A total of 101 patients consecutively treated for Stage I–III non–small-cell lung cancer were studied. Each patient underwent CT and FDG-hybrid PET for simulation treatment in the same treatment position. Images were coregistered using five fiducial markers. Target volume delineation was initially performed on the CT images, and the corresponding FDG-PET data were subsequently used as an overlay to the CT data to define the target volume. Results: 18F-fluoro-deoxy- d -glucose-PET identified previously undetected distant metastatic disease in 8 patients, making them ineligible for curative conformal radiotherapy (1 patient presented with some positive uptake corresponding to concomitant pulmonary tuberculosis). Another patient was ineligible for curative treatment because the fused PET-CT images demonstrated excessively extensive intrathoracic disease. The gross tumor volume (GTV) was decreased by CT-PET image fusion in 21 patients (23%) and was increased in 24 patients (26%). The GTV reduction was ≥25% in 7 patients because CT-PET image fusion reduced the pulmonary GTV in 6 patients (3 patients with atelectasis) and the mediastinal nodal GTV in 1 patient. The GTV increase was ≥25% in 14 patients owing to an increase in the pulmonary GTV in 11 patients (4 patients with atelectasis) and detection of occult mediastinal lymph node involvement in 3 patients. Of 81 patients receiving a total dose of ≥60 Gy at the International Commission on Radiation Units and Measurements point, after CT-PET image fusion, the percentage of total lung volume receiving >20 Gy increased in 15 cases and decreased in 22. The percentage of total heart volume receiving >36 Gy increased in 8 patients and decreased in 14. The spinal cord volume receiving at least 45 Gy (2 patients) decreased. Multivariate analysis showed that tumor with atelectasis was the single independent factor that resulted in a significant effect on the modification of the size of the GTV by FDG-PET: tumor with atelectasis (with vs. without atelectasis, p = 0.0001). Conclusion: The results of our study have confirmed that integrated hybrid PET/CT in the treatment position and coregistered images have an impact on treatment planning and management of non–small-cell lung cancer. However, FDG images using dedicated PET scanners and respiration-gated acquisition protocols could improve the PET-CT image coregistration. Furthermore, the impact on treatment outcome remains to be demonstrated.

Resume Objectif de l'etude. – Evaluer dans une serie retrospective l'impact du recalage d'images de tomographie par emission de positons (TEP) au 18 fluorodeoxyglucose ([18F]-FDG) et detection en coincidence (TEDC) par gamma-camera et d'images de simulation virtuelle par tomodensitometrie pour la radiotherapie conformationnelle des cancers bronchiques non a petites cellules. Patients et methodes. – Les dossiers de cent un patients consecutifs atteints d'un cancer bronchique non a petites cellules de stades I a III ont ete etudies. Tous les patients ont eu une tomographie par emission de positons au [18F]-FDG et detection en coincidence et une simulation virtuelle par tomodensitometrie dans la meme position de traitement. Cinq reperes cutanes ont permis la mise en correspondance des images tomographiques par emission de positons et tomodensitometriques de maniere semi-automatique. Dans un premier temps, le volume cible a ete defini par imagerie tomodensitometrique seule. Dans un deuxieme temps, les contours du volume cible ont ete redefinis sur les deux types d'images simultanement affichees a l'ecran de la console d'imagerie. Resultats. – La tomographie par emission de positons au [18F]-FDG a permis d'identifier des metastases a distance occultes chez huit patients (dont un faux-positif pour une partie des images d'hyperfixation dans les parenchymes pulmonaires correspondant a une tuberculose pulmonaire concomitante), et un patient est devenu egalement ineligible pour une radiotherapie conformationnelle a visee curative par l'importance du volume tumoral apres fusion d'images. Apres fusion d'images tomographiques par emission de positons et tomodensitometriques, le volume tumoral macroscopique (GTV) a ete reduit chez 21 patients (23 %) et augmente chez 24 patients (26 %). La reduction du volume tumoral macroscopique etait superieure ou egale a 25 % dans sept cas, par reduction du volume tumoral macroscopique pulmonaire dans six cas, dont trois avec atelectasie, et par reduction du volume tumoral macroscopique ganglionnaire mediastinal dans un cas. L'augmentation du volume tumoral macroscopique etait superieure ou egale a 25 % dans 14 cas, par detection d'une atteinte ganglionnaire mediastinale dans trois cas, et par augmentation du volume tumoral macroscopique pulmonaire dans 11 cas, dont quatre avec atelectasie. Sur 81 patients ayant recu une dose superieure ou egale a 60 Gy au point ICRU, le pourcentage de volume pulmonaire sain recevant plus de 20 Gy a ete augmente dans 15 cas et reduit dans 22 cas. Le pourcentage de volume cardiaque recevant au moins 36 Gy a ete augmente chez huit patients et reduit chez 14 patients. Le volume de moelle epiniere recevant au moins 45 Gy (deux patients) a ete diminue. Apres analyse multifactorielle, un seul facteur independant a eu un impact significatif sur la modification du volume tumoral macroscopique : la presence d'une atelectasie ( p = 0,0001). Conclusion. – Notre etude confirme que la fusion d'images tomographiques par emission de positons au [18F]-FDG et detection en coincidence et d'images de simulation virtuelle par tomodensitometrie pour la radiotherapie conformationnelle de cancer bronchique non a petites cellules a non seulement un impact sur la strategie therapeutique, mais aussi sur la planification de la radiotherapie. L'imagerie par tomographie par emission de positons–tomodensitometrie dediee, utilisant une methode de recalage d'images elastique, tenant compte des mouvements de la cage thoracique lies a la respiration avec un protocole de controle des mouvements respiratoires, devrait ameliorer la precision de la technique de recalage d'images metaboliques et anatomiques. Cependant, l'interet de ces techniques demanderait a etre confirme par controle histopathologique et l'impact sur le controle tumoral local et la survie reste a demontrer.

Use of erythropoietin (EPO) for chemotherapy-induced anemia and biphosphonates (BP) for bone metastasis has increased steadily. However, there are no guidelines on their use in many situations such as non small cell lung carcinoma (NSCLC), which frequently alters quality of life markedly. Therefore, a multicentric survey was designed to assess the treatment of anemia and bone metastasis in chemotherapy-treated patients with non-small-cell lung carcinoma. Nine representative centers of the oncology working party of the French respiratory society (Groupe d'Oncologie de la Societe de Pneumologie de Langue Francaise) participated. Inclusion criteria were stage IV NSCLC and at least one course of chemotherapy in the last 3 months. A total of 148 and 50 patients (pts) were included in the anemia and bone metastasis surveys, respectively. Anemia was present in 60.8% of patients, and was not treated in 75%; 15 patients received EPO (10.1%). Independent predictors of EPO use were presence of anemia-related symptoms, hemoglobin level, age and center: the rate of prescription in patients with anemia varied from 13 to 73% between centers. BP were administered in 38% of patients with bone metastasis. Independent predictors of BP use were calcium serum level, pain, and center with a rate of prescription ranging from 0 to 80% between centers. This study reveals that, in France, most patients with anemia are not treated, EPO being seldom prescribed. The use of both EPO and BP is highly variable between centers. Guidelines on the use of these supportive treatments could help improve the care for lung cancer patients receiving chemotherapy.

Resume Les cancers bronchiques a petites cellules constituaient une entite clinique de pronostic gravissime jusqu’en 1980, date a partir de laquelle fut mise en evidence leur tres frequente chimiosensibilite : environ 90 % de reponses objectives pouvant, en cas de reponse complete, amener a une guerison. L’obtention de celle-ci, encore rare, depend de la qualite du traitement administre encore plus que de l’etendue de la maladie. L’emploi de protocoles de polychimiotherapies a fortes doses est une necessite fondamentale, mais expose a une toxicite, surtout hematologique, limitante. La duree des traitements a ete raccourcie a six cures environ en cas de reponse complete avec, si possible, une periodicite rapprochee. Cette chimiotherapie efficace ne se concoit que dans le cadre d’une strategie plus large, notamment par association a d’autres moyens therapeutiques : radiotherapie thoracique des formes apparemment localisees, irradiation cephalique curative ou preventive, traitements medicaux adjuvants. En cas de rechute, des chimiotherapies de deuxieme ligne sont proposees, mais leur efficacite est moindre, limitee dans le temps.

Aspergillus fumigatus infection in hospitalized immunocompromised patients often raises suspicion regarding the potential for hospital acquisition. Hospital staff have an important responsibility in implementing preventive measures, especially since the advent of current legislation concerning hospital-acquired infections. There have been high expectations that molecular typing methods might determine the source of Aspergillus fumigatus, a ubiquitous mould. The aim of the present epidemiological study, was therefore, to identify the origin(s) of Aspergillus infection in six well-documented patients. All the clinical strains (N=33), and those from hospital (N=14) and home environments (N=34) were isolated according to a standardized protocol and typed by sequence-specific DNA primer analysis. The results confirmed the huge biodiversity of the A. fumigatus population, and consequently the difficulty in ascertaining a hospital source of the infection, as opposed to infections due to other Aspergillus species less frequently encountered.

An eight-year fungal environmental surveillance was carried out in 15 operating theatres and two haematological units. Sampling was performed twice a year in each room, using contact plates for plane surfaces and sterile swabs for grids. From 1992 to 1999, individual rooms in the 17 units were sampled on 1094 occasions and 3822 samples were collected. The percentage of rooms without fungus increased regularly between 1992 and 1999 (41.1% and 74.8%, respectively). The units were classified according to the fungal contamination during the eight years: the operating theatres which required the highest protection (cardiological, thoracic, vascular, hand, orthopaedic and neurosurgery) and the adult haematological unit showed least contamination (71.8% rooms were negative). The most frequent species isolated were Penicillium spp. (28.4%), Cladosporium spp. (15.6%) and Aspergillus spp. (7.6%). Aspergillus fumigatus was rarely isolated (3.7%), and was mainly isolated at the beginning of the study. This study demonstrates that environmental control programmes are effective in reducing environmental mould contamination and could be useful in establishing exposure guidelines, especially by defining an acceptable level of biocontamination in zones at risk.

To evaluate whether preoperative chemotherapy (PCT) could improve survival in resectable stage I (except T1N0), II, and IIIA non-small-cell lung cancer (NSCLC).A randomized trial compared PCT to primary surgery (PRS). PCT consisted of two cycles of mitomycin (6 mg/m(2), day 1), ifosfamide (1.5 g/m(2), days 1 to 3) and cisplatin (30 mg/m(2), days 1 to 3), and two additional postoperative cycles for responding patients. In both arms, patients with pT3 or pN2 disease received thoracic radiotherapy.Three hundred fifty-five eligible patients were randomized. Overall response to PCT was 64%. There were two preoperative toxic deaths. Postoperative mortality was 6.7% in the PCT arm and 4.5% in the PRS arm (P =.38). Median survival was 37 months (95% confidence interval [CI], 26.7 to 48.3) for PCT and 26.0 months (95% CI, 19.8 to 33.6) for PRS (P =.15). Survival differences between both arms increased from 3.8% (95% CI, 1.3% to 25.1%) at 1 year to 8.6% (95% CI, 2.64% to 24.4%) at 4 years. A quantitative interaction between N status and treatment was observed, with benefit confined to N0 to N1 disease (relative risk [RR], 0.68; 95% CI, 0.49 to 0.96; P =.027). After a nonsignificant excess of deaths during treatment, the effect of PCT was significantly favorable on survival (RR, 0.74; 95% CI, 0.56 to 0.99; P =.044). Disease-free survival time was significantly longer in the PCT arm (P =.033).Although impressive differences in median, 3-year, and 4-year survival were observed, they were not statistically significant, except for stage I and II disease.

The gold standard laboratory tests used to diagnose invasive Candida infection (ICI) are based on the in vitro culture of blood or samples from other sterile sites. However, these tests have limited sensitivity (Se) and are generally not diagnostic until late in the infectious process. The Serion Candida mannan kit was evaluated for the diagnosis of ICI at Grenoble University Hospital (France) between 2007 and 2011. The results were then compared with worldwide data published between 1997 and 2011. This retrospective study was based on follow-up from the investigation of 162 patients of whom 91 had proven ICI; 13 had Candida colonization index (CCI) scores ≥0.42, positive mannan tests, with nonconcomitant infections; and 58 had no evidence of Candida infection. Candida albicans, C. glabrata, C. tropicalis, and C. parapsilosis were the etiologic agents in 104 patients. For patients with or without ICI, the 12-week mortality rates were 35/104 (33.7%) and 6/58 (10.3%), respectively. The mannan diagnostic specificity was 51% and Se was 77%. However, in the meta-analysis (n = 1,536), values were 86% and 62%, respectively. Positive mannan test results may appear early (median 6 days) in the development of candidemia and have moderate diagnostic value for ICI, with a negative predictive value of 83%. In patients at risk of ICI with negative candidemia, the combination of Candida mannan test data with a CCI score ≥0.42 may improve the diagnosis of probable ICI.

Schematically, the current systemic antifungal agents can be divided into two categories: that of the antifungal antibiotics, which include griseofulvin and amphotericin B (AMB), and that of the chemical agents, which comprise all of the other molecules, flucytosine (5FC), the extremely rich series of azoles and, more recently, the allylamines and echinocandins. Given their value in the treatment of systemic mycoses, the authors discuss the three systemic azoles currently commercially available in parallel with voriconazole, which is currently available under an authorization for compassionate use, and conclude with the most recent triazoles under development. The azole compounds possess a relatively broad spectrum against numerous pathogenic or opportunistic fungal species, a spectrum that is exceeded only by that of AMB. Although all of these derivatives share good activity against some of these fungi (such as Candida albicans, Candida neoformans, and dimorphic fungi), major differences have been found in vitro and subsequently confirmed in animals and in clinical trials. Despite the considerable advances in antifungal therapy over the last few years, we are still far from possessing the ideal antifungal and progress is still necessary. Fungal infections remain a matter of concern, particularly in severe neutropenia (frequent inefficacy in disseminated mycoses) and AIDS (frequency of relapses and/or resistance in oroesophageal candidosis and cryptococcosis).

The genotypes of 52 strains of Aspergillus fumigatus isolated from 12 patients with invasive aspergillosis were investigated using three typing methods (random amplified polymorphic DNA, sequence-specific DNA polymorphism, and microsatellite polymorphism) combined with multilocus enzyme electrophoresis. Isolates were from patients hospitalized in three different geographic areas (Lyon, France; Grenoble, France; and Milan, Italy). In each case, the genetic polymorphism of several colonies (two to five) within the first respiratory clinical sample was studied. For the 52 isolates tested, random amplified polymorphic DNA identified 8 different genotypes, sequence-specific DNA polymorphism identified 9 different types, and microsatellite polymorphism identified 14 types. A combination of these results with multilocus enzyme electrophoresis study identified 25 different types within the sample studied. We identified 3 patients (of the 12 studied) who carried a single genotype; 6 patients were infected by two genotypes, 1 patient had four genotypes, while the last patient had five. A combination of typing methods provided better discrimination than the use of a single method. Typing methods revealed a population structure within each geographical site, suggesting that the epidemiology of A. fumigatus should be considered separately for each of these geographic areas. This study demonstrates the usefulness of combining several typing methods in reaching an understanding of the epidemiology of A. fumigatus and clarifies whether it is sufficient to type one isolate from each specimen to determine the strain involved in invasive aspergillosis.

The genotypes of 50 isolates of Aspergillus fumigatus from 11 patients with invasive aspergillosis, obtained from three hospitals in different geographical areas, were determined by multilocus enzyme electrophoresis (MLEE). The study analysed the genetic polymorphism of multiple isolates from the first sample. Seven of the 14 enzymic loci studied were polymorphic, giving rise to eight different electrophoretic types. For nine of 11 patients studied, no polymorphism was observed in isolates within the first clinical sample. Analysis of genetic distance between electrophoretic types demonstrated a genetic heterogeneity within each geographical site. Moreover, some genotypes were preferentially found in a given area and this revealed a population structure within these geographical sites. Therefore, the epidemiology of A. fumigatus should be considered separately for each of these areas. The multiple discriminatory markers of MLEE seem to provide a powerful tool for increasing the understanding of the biology of this fungus.

In a surveillance study of candidemia in cancer patients that was conducted by the European Organization for Research and Treatment of Cancer, 249 episodes were noted; Candida albicans was isolated in 70% (63) of the 90 cases involving patients with solid tumors (tumor patients) and in 36% (58) of the 159 involving those with hematologic disease (hematology patients). Neutropenia in tumor patients and acute leukemia and antifungal prophylaxis in hematology patients were significantly associated with non-albicans candidemia in a multivariate analysis. Overall 30-day mortality was 39% (97 of 249). In a univariate analysis, Candida glabrata was associated with the highest mortality rate (odds ratio, 2.66). Two multivariate analyses showed that mortality was associated with older age and severity of the underlying disease. Among hematology patients, additional factors associated with mortality were allogeneic bone marrow transplantation, septic shock, and lack of antifungal prophylaxis.

This study investigated the source of infection and strain relatedness of Aspergillus fumigatus isolates from bronchial colonisation and invasive aspergillosis (IA) in four transplant patients. Environmental isolates from the patient's home and from the hospital and infecting isolates were obtained for patient A who developed IA. Clinic environmental and colonising isolates were obtained for patient B. Sequential isolates were obtained from various organs from patient C who developed IA and also from patient D who had a bronchitic aspergillosis that developed into IA. Ninety-one A. fumigatus isolates were analysed by three typing methods: multi-locus enzyme electrophoresis (MLEE), random amplified polymorphic DNA (RAPD) and sequence-specific DNA primers (SSDP). The three combined typing methods demonstrated a greater differentiation of isolates than the typing methods used separately or in pairs. This demonstrated the genotypic variability of A. fumigatus and facilitated better epidemiological analysis. Large polymorphisms were demonstrated for each patient isolate between and colonies within various samples. The relatedness of the isolates suggested nosocomially acquired aspergillosis for patient B, but the source of infection for patient A remained unclear. The results suggested at least three multiple infections among the four patients. This study enabled the identification of the source of infection and strain relatedness, which in turn facilitates the development of preventive measures for patient management in the future.

Les infections fongiques sont une cause de morbidite et de mortalite chez les sujets immunodeprimes. Parmi ces infections fongiques, Candida albicans est le pathogene le plus frequemment retrouve. Une technique commerciale de PCR en temps reel utilisant le kit LightCycler Candida kit M GRADE a ete testee pour detecter la presence de C. albicans dans le sang total et dans le serum artificiellement infectes avec, respectivement, des levures et de l'ADN de C. albicans. La sensibilite obtenue etait de 5 x 10 2 UFC/ml dans le sang total et cinq copies de genome par millilitre dans le serum. C'est la premiere fois que ce kit commercial de PCR est teste et aucune technique commerciale de PCR en temps reel n'a jusqu'a present ete decrite pour detecter C. albicans dans des echantillons biologiques. Cependant, le kit LightCycler Candida kit M GRADE reste d'un interet limite, car s'il permet de detecter C. albicans, il ne detecte pas les autres especes de Candida.

A monoclonal antibody (MAb; MAb 6B3) which reacts specifically with a cell wall antigen found in all strains or isolates of Candida krusei was developed. MAb 6B3 was extensively tested by immunofluorescence assay for cross-reaction with many Candida , Cryptococcus , Saccharomyces , Trichosporon , and Rhodotorula species and was found to react only with the species C. krusei . The specific epitope is expressed on the surface of fungal cells and appears to reside on a protein moiety. Taking into account the increasing importance of fluconazole-resistant strains in nosocomial fungal infections, the very high degree of specificity of this MAb for C. krusei could be useful for the routine detection of C. krusei in culture or in tissue samples.

This paper examines how, in use, culturally-provided tools can be said to embody knowledge and distribute thinking. It focuses on the routine procedures used by medical professionals to investigate patient complaints and examines explicit and implicit contributions of these conventional procedures to distributed thinking in clinical encounters in medicine. After characterizing these tools, examples of how the tools guide and constrain medical problem solving are provided. The tools support the development and exercise of the routines characteristic of medical expertise, while at the same time preserving the nonroutine, controlled deliberation necessary for sound and ethical medical care. The paper concludes with ways in which the tools' role in thinking can be promoted through medical education, particularly during students' early clinical exposure: (a) Organizing learning experiences that expose the tools' meanings; (b) exploiting the benefits of small group work to promote collaborative and individual competencies in distributed systems; and (c) explicitly utilizing the products of thinking with these tools to further the goals shared by participants in clinical encounters.

Interleukin-13 (IL-13) is a cytokine secreted by activated T cells and shares most but not all biological activities with interleukin-4 (IL-4). Both cytokines play an important role as a switch factor directing synthesis of IgE; they act on monocytes and endothelial cells, but unlike IL-4, IL-13 does not act on T cells. These cytokines have both common and distinct components in their respective receptors. Based on sequence similarity shared by cytokine receptor family members, we have identified a cDNA encoding the human IL-13 receptor (IL-13R). This cDNA was used to examine the pattern of IL-13R mRNA expression by Northern blot analyses of poly(A)+RNA purified from different human tissues and cell lines. Among several myeloma cell lines analyzed, the U266 cell line was the only one found to express IL-13R transcripts. This cell line is also the only one described as producing IgE. The IL-13R gene was mapped to chromosome Xq24 byin situhybridization. Interestingly, this locus is near that of the CD40 ligand gene, the product of which is also involved, like IL-13, in proliferation and IgE isotype switching of human B cells. The human IL-13R gene maps between two cytokine receptor genes located on the chromosome arm Xq region: the interleukin-2 receptor γ chain gene (Xq13.1) and the interleukin-9 receptor gene (Xq28). The lack of nucleotide sequence similarity suggests unrelated evolutionary pathways between these receptor genes.

Hybrid organic−inorganic nanocomposites have been synthesized through hydrolysis and co-condensation between (4-(amino-N,N-(diethoxydiurethano)propyltriethoxysilane)-2-methyl-4‘-nitroazobenzene (ICTES−Red 17) and tetramethoxysilane (TMOS). From the resulting sols, coatings a few microns in thickness can be deposited. It has been shown that the aging time of the sol and the thermal treatment of the coatings are both important to improve the second-harmonic-generation (SHG) response and its temporal stability. The hybrid coatings 4.2 μm thick, with a 50/50 ICTES−Red 17-TMOS molar composition, exhibit the highest nonresonant SHG response (d33 = 150 pm/V, λ = 1.34 μm) reported up to now for sol−gel-derived NLO materials. Moreover, they also exhibit a good stability at 80 °C.

A retrospective study was conducted in France to investigate Fusarium infections which are now recognized as emerging opportunistic infections. The clinical and mycological findings for 31 cases diagnosed between 1984 and 1993 by members of the French Groupe d'Etudes des Mycoses Opportunistes were analysed. All suffered from haematological disease, most often acute leucaemia (n = 19). Twenty-two had received cytostatic chemotherapy and ten had undergone bone marrow transplantation. Prolonged aplasia and pancytopenia were present in 18 and 11 patients, respectively. Skin (61%) and blood (42%) were the sites most frequently involved. Fusarium solani (n = 7), Fusarium oxysporum (n = 7), Fusarium verticilloides (n = 7) were the species most frequently isolated. Nine antifungal treatments were used, associated with colony-stimulating factors in five cases. None was unambiguously superior to all the others. The overall mortality was 51·6% with a specific mortality ≥ 25·8%. The disseminated form of the infection...

A new immunoelectrophoresis system, the Paragon system, was evaluated in three different hospital centres with the aim of improving standardization of the serodiagnosis of human aspergillosis. To select the most efficient antigen, various commercial and home-made antigens were first tested on 19 sera from 19 patients with highly probable aspergillosis. The value measured using the Paragon anti-Aspergillus antibody detection system was then compared with the results obtained by conventional serological diagnostic methods (conventional immunoelectrophoresis, enzyme linked-immunosorbent assay, indirect immunofluorescence): this step was performed using the first 19 sera as well as 16 other sera from 13 patients with suspected aspergillosis. Concordant results were obtained in 28 cases. The discrepancies observed with seven sera were probably related to differences in the nature of the antigens. Paragon immunoelectrophoresis proved to be a practicable technique requiring only a small amount of serum and giving results within a shorter time than competitive methods (24-48 h). Its major drawbacks compared with conventional immunoelectrophoresis are some difficulties in reading, fewer precipitin lines and the relatively high cost of routine analysis.

Surmmary A possible relationship between the ability of Aspergillus fumigatus strains to invade tissues and genetic polymorphism was studied by random amplified polymorphic DNA (RAPD) analysis. One hundred randomly designed oligonucleotide decamers were examined with DNA of three reference strains, eight environmental isolates and 21 isolates from two distinct clinical situations: Non-invasive aspergillosis (predominantly aspergilloma) and invasive aspergillosis. One primer (OPQ 6) was found to generate a reproducible amplification product that enabled distinction between the two groups according to the presence or absence of a 0.95-kb fragment that correlated with the nature of the infection (non-invasive or invasive) and immune status of the patient. The results indicated that the pathogenicity of A. fumigatus was related not only to the host's immune status but also to the virulence of the strain of A. fumigatus.

Cytological specimens containing large amounts of mucus and/or blood are often a considerable problem as far as preparation and especially screening are concerned. The ThinPrep method, which uses a mucolytic and hemolysing solution and prepares slides automatically, eliminates difficulties in both areas. Comparing ThinPreps to conventionally prepared samples reveals equivalent or even superior cellular preservation. Cells are spread in a thin layer, mostly with only a minimal amount of residual mucus or blood. Screening is consequently much easier and faster. The time-saving effect does not compromise the diagnostic accuracy, as we could demonstrate with an 92% overall agreement in both procedures. The difference of 8% could possibly be attributed to inadequate splitting of the samples.

The effectiveness of galactomannan detection with the Platelia test was evaluated in a prospective study of 3,327 sera from 807 patients. The specificity was 99.6% (748 of 751 cases). For the groups of patients with proven and probable invasive aspergillosis, the sensitivity was 50.0% (17 of 34 cases). The disappointing sensitivity associated with the presence of rare false-positive cases underlines the limits of this test.

International audience; OBJECTIVES: This study aims at describing the evolution of the epidemiology of invasive aspergillosis (IA) in a French University Hospital focussing on nosocomial cases, in order to assess the efficiency of the environmental preventive measures which were implemented. METHODS: From 2003 to 2009, IA cases were reviewed monthly and classified according to the EORTC/MSG criteria and the origin of contamination. RESULTS: Five proven and 65 probable IA cases were diagnosed. Most of the cases (74.3%) occurred in patients with haematological malignancies. Incidences of IA and nosocomial IA (NIA) were 0.106 and 0.032 cases per 1000 admissions, respectively. All the 21 NIA cases occurred in the absence of air treatment (laminar air flow facilities or Plasmair decontamination units) and/or during construction works. The 3-month and 1-year overall survival rates were 50.6% [38.2-61.7] and 31.1% [20-42.9] respectively, and did not differ according to the origin of contamination. CONCLUSION: Nosocomial IA still accounted for a third of all IA cases diagnosed from 2003 to 2009 and mainly occurred in the absence of environmental protective measures, which were confirmed to be effective when applied. Our results show that extension and/or reinforcement of these measures is needed, especially in the haematology unit and during construction works.

Summary. Itraconazole, a new triazole antifungal agent, has marked in vitro activity against filamentous fungi, particularly Aspergillus. We studied three groups of patients suffering from aspergillosis (16 cases): six affected with aspergilloma, three with allergic bronchopulmonary aspergillosis and seven with invasive aspergillosis. The survey consisted in clinical, radiological, mycological and serological evaluations with respect to drug plasma levels. Itraconazole was given at a dosage of 200–400 mg day-1 for periods ranging from 14 to 488 days. Out of the 16 patients, nine responded to therapy (recovery or improvement) and one failed to respond. Three patients improved but experienced relapses and three others could not be evaluated because of liver function disorders, so that treatment had to be stopped prematurely. Zusammenfassung. Itraconazol, ein neues antimykotisches Triazol hat eine in vitro nachgewiesene Wirkung gegen Fadenpilze, im besonderen Aspergillus. Wir untersuchten 3 Patientengruppen, die an Aspergillose litten (16 Falle); 6 davon waren von einem Aspergillom betroffen, 3 Falle mit allergischer bronchopulmonarer Aspergillose und 7 Falle mit invasiver Aspergillose. Die Uberwachung bestand aus klinischen, radiologischen, mykologischen und serologischen Untersuchungen mit Berucksichtigung der Medikamentenspiegel im Plasma. Itraconazol wurde in einer Dosis von 200–400 mg/Tag fur die Dauer von 14–488 Tagen gegeben. Von 16 Patienten reagierten 9 mit Heilung oder Besserung, 1 Patient reagierte nicht auf die Therapie. Der Zustand von 3 weiteren Patienten bessertc sich, sie erlitten jedoch Ruckfalle. Drei andere Falle konnten wegen Storungen der Leberfunktion nicht berucksichtigt werden, so das die Behandlung in diesen Fallen sofort beendet werden muste.

International audience; OBJECTIVES: Antifungal prescription practices have changed over the last decade, and the impact of these changes is unclear. Our objective here was to evaluate the effect of antifungal drug use on the distribution and drug susceptibility of Candida spp. in a French intensive care unit (ICU). METHODS: Antifungal drug use was measured as the number of defined daily doses per 1000 hospital days (DDDs/1000HD). The distribution of Candida spp. over a 6 year period (2004-09) and the MICs of antifungal drugs over 2007-09 were determined. Statistical analyses were performed to assess relationships between antifungal drug use, Candida spp. distribution and MIC changes over time. RESULTS: Of 26,450 samples from 3391 patients, 1511 were positive for Candida spp. Candida albicans predominated (52.5%), followed by Candida glabrata (16.6%) and Candida parapsilosis (7.5%). C. parapsilosis increased significantly, from 5.7% in 2004 to 12.5% in 2009 (P = 0.0005). Caspofungin use increased significantly between 2004 (17.9 DDDs/1000HD) and 2009 (69.9 DDDs/1000HD) (P < 0.0001). Between 2007 and 2009, the increase in caspofungin use correlated significantly with the increase in caspofungin MICs displayed by C. parapsilosis (P < 0.0001) and C. glabrata (P = 0.03). Amphotericin B consumption changed over time and correlated with an increase in amphotericin B MICs for C. albicans (P = 0.0002) and C. glabrata (P = 0.0005). Significant declines occurred in both fluconazole use (P < 0.0001) and fluconazole MICs of C. albicans (P < 0.001) CONCLUSIONS: Antifungal drug use in the ICU is associated with major changes in the distribution and drug susceptibility of Candida spp.

We compared the E-test method to that of the Neo-Sensitabs tablet diffusion assay for evaluating the in vitro susceptibility of 100 clinical isolates of filamentous fungi (Aspergillus spp., Fusarium spp., Scedosporium spp., zygomycetes and other molds) to amphotericin B, itraconazole, voriconazole, caspofungin, and posaconazole. We determined the categorical agreement level between E-test minimum inhibitory concentrations (MIC) and tablet end-points, as opposed to the following disagreement parameters: very major error - resistant parameter (R) in E-test and susceptible (S) in tablet; major error - S by E-test and R by tablet; minor error - shifts between S and susceptible dose-dependent (S-DD) or S-DD and R. We also performed linear regression analyses and computed Pearson's correlation coefficients (R values) between the log transforms of MICs and the inhibition zone diameters of the five studied antifungal agents. For itraconazole we obtained 97% categorical agreement and R = -0.727. Categorical agreement for caspofungin and voriconazole was 96% and R =-0.821 and R = -0.789, respectively. For posaconazole the categorical agreement was 94% and R =-0.743. Amphotericin B exhibited a lower degree of agreement (76%, R = -0.672), especially in studies of Aspergillus spp. Our results suggest a potential value of the Neo-Sensitabs assay for in vitro susceptibility testing of molds to itraconazole, voriconazole, caspofungin and posaconazole, while amphotericin B exhibited an overall lower degree of agreement.

Deoxyribonucleic acid (DNA) content of bronchopulmonary neuroendocrine tumours was measured by flow cytometry in order to investigate correlations between ploidy, S-phase fraction (SPF) and two histological classifications (World Health Organization (WHO), Warren and Gould), and clinical staging. A paraffin-embedded technique was used on 20 surgical specimens. Cases comprised (according to the classification of Warren and Gould) 7 carcinoids, 3 well-differentiated neuroendocrine carcinomas (WDNC), 6 intermediate neuroendocrine carcinomas (INC), and 4 small cell neuroendocrine carcinomas (SCNC). DNA aneuploidy was demonstrated in 3 out of 7 of the carcinoids, 3 out of 9 of the WDNCs and INCs, and 2 out of 4 of the SCNCs. A variable SPF was found in each group, except for the SCNCs which showed a constantly high SPF. In our small series, no correlation was noted between high SPF or aneuploidy and metastases. In conclusion, we observed no diagnostic value of malignancy for DNA aneuploidy. The SCNC group appeared to be an homogeneous group according to the SPF compared to the small cell carcinoma (SCC) group of the WHO classification. This and the prognostic incidence of high SPF need to be further studied.

Resume Dans le cadre d'une etude prospective, les auteurs ont compare chez les patients infectes par le VIH, les caracteristiques cliniques, radiologiques, biologiques et diagnostiques des pneumocystoses pulmonaires (PPC) en fonction de l'existence ou non d'une prophylaxie specifique. L'etude a porte sur 386 patients suspects de PPC dont 201 recevaient une prophylaxie specifique. L'expectoration induite et/ou le lavage broncho alveolaire ont permis le diagnostic de 89 PPC dont 21 survenant malgre la prophylaxie. En dehors du nombre de lymphocytes circulants CD4, significativement plus bas chez les patients sous prophylaxie, il n'y a pas de difference significative entre les deux groupes. Ainsi, l'existence d'une prophylaxie specifique ne doit pas faire modifier la strategie diagnostique de la PPC chez les patients infectes par le VIH.

L’echo endoscopie œsophagienne est sous-utilisee en milieu pneumologique. Ses indications principales se situent au niveau du bilan d’extension ganglionnaire des cancers broncho-pulmonaires et du diagnostic d’adenopathies mediastinales de cause inconnue. Elle explore particulierement bien les regions sous-carenaire, para-œsophagienne et de la fenetre aortico-pulmonaire et permet des ponctions a l’aiguille, guidees par les ultrasons avec une grande efficacite et une excellente securite. En ces sites, elle devrait etre preferee a la ponction transthoracique sous scanner et devrait toujours preceder un abord chirurgical pour essayer de l’eviter.

Whole-body (18)F-deoxyglucose positron emission tomography (FDG-PET) has the potential to improve the management of non-small-cell lung cancer (NSCLC). We prospectively evaluated the impact of combining FDG-PET with conventional staging methods, including computed tomography (CT), on the staging and management of patients with potentially resectable NSCLC.Ninety-four consecutive patients with newly diagnosed/suspected NSCLC were enrolled. Each patient was first staged by using conventional methods, and then by FDG-PET. FDG-PET results were forwarded in a sealed envelope and divulged at the weekly staff meeting on staging and treatment, only after "Decision 1", based on conventional staging, had been reached by consensus; reevaluation taking FDG-PET into account yielded "Decision 2". The validity of these latter decisions was analyzed retrospectively.Eighty-nine patients were eligible. Relative to standard imaging, FDG-PET led to clinical staging changes in 26 (29.2%) patients. The stage was lowered in eight cases (9%) and raised in 18 cases (20.2%). "Decision 2" differed from "Decision 1" in 19 patients, modifying the surgical procedure in four cases, indicating other investigations to confirm FDG-PET evidence of metastases in 12 cases, or modifying the medical treatment in three cases. These modifications were retrospectively justified in 9/19 cases, and consisted of 2/4 modifications of the surgical procedure (one hilar and one adrenal metastasis not confirmed histologically), 4/12 further investigations (axillary and liver biopsies, mediastinoscopy, occult colon cancer) and three indications for palliative treatment, in patients who all died within 3 months after FDG-PET.Based on FDG-PET, management was modified in 19/89 (21.3%) patients, but these changes were justified in only 9/89 patients (10.1%). FDG-PET can detect asymptomatic local and distant metastases and improves the preoperative assessment of NSCLC, thereby avoiding unnecessary surgery. However, histological verification is required because of the risk of false-positive results.