The Board of Regents of the American College of Chest Physicians (CHEST) has finalized the appointment of Stephen J. Welch as Executive Vice President and Chief Executive Officer for CHEST. Welch had been serving as the interim EVP/CEO since May 2016. Prior to this appointment, he served in a senior staff role at CHEST for 22 years, most recently as Publisher and Senior Vice President of Publications and Digital Content, which includes managing the organization’s flagship scientific journal, CHEST®.
Dr. Stephen Welch“We appreciate the exceptional performance of Steve, his senior team, and the entire CHEST staff during this transition in executive leadership. We are excited about the opportunity to work with Steve in his new role going forward, as we begin outlining CHEST’s strategic plan for the next 5 years,” said CHEST President Gerard A. Silvestri, MD, MS, FCCP.
In response to the announcement, Steve remarked, “I am sincerely humbled and honored to have this opportunity and am excited for the future of CHEST, a dynamic, innovative organization that is doing great things, and we will continue our track record of excellent performance.”
The Board of Regents of the American College of Chest Physicians (CHEST) has finalized the appointment of Stephen J. Welch as Executive Vice President and Chief Executive Officer for CHEST. Welch had been serving as the interim EVP/CEO since May 2016. Prior to this appointment, he served in a senior staff role at CHEST for 22 years, most recently as Publisher and Senior Vice President of Publications and Digital Content, which includes managing the organization’s flagship scientific journal, CHEST®.
Dr. Stephen Welch“We appreciate the exceptional performance of Steve, his senior team, and the entire CHEST staff during this transition in executive leadership. We are excited about the opportunity to work with Steve in his new role going forward, as we begin outlining CHEST’s strategic plan for the next 5 years,” said CHEST President Gerard A. Silvestri, MD, MS, FCCP.
In response to the announcement, Steve remarked, “I am sincerely humbled and honored to have this opportunity and am excited for the future of CHEST, a dynamic, innovative organization that is doing great things, and we will continue our track record of excellent performance.”
The Board of Regents of the American College of Chest Physicians (CHEST) has finalized the appointment of Stephen J. Welch as Executive Vice President and Chief Executive Officer for CHEST. Welch had been serving as the interim EVP/CEO since May 2016. Prior to this appointment, he served in a senior staff role at CHEST for 22 years, most recently as Publisher and Senior Vice President of Publications and Digital Content, which includes managing the organization’s flagship scientific journal, CHEST®.
Dr. Stephen Welch“We appreciate the exceptional performance of Steve, his senior team, and the entire CHEST staff during this transition in executive leadership. We are excited about the opportunity to work with Steve in his new role going forward, as we begin outlining CHEST’s strategic plan for the next 5 years,” said CHEST President Gerard A. Silvestri, MD, MS, FCCP.
In response to the announcement, Steve remarked, “I am sincerely humbled and honored to have this opportunity and am excited for the future of CHEST, a dynamic, innovative organization that is doing great things, and we will continue our track record of excellent performance.”
Explore the talent of Canadian artists and the culture of Toronto during CHEST Annual Meeting 2017.
Over the last decade, Toronto’s art scene has moved to the former industrial district, creating a new home for galleries, especially those of contemporary art. While Toronto’s galleries may not be very busy outside of opening nights, they allow you to visit at any time and admire the artwork at your own pace. Along with art galleries, there are many options available to experience music and performance art, as well as family-friendly activities. Here are a few places you’ll want to visit:
Art Galleries
The Power Plant (4-minute drive), one of Toronto’s most established contemporary art galleries, is located within Harbourfront in an actual power plant - one that was in operation for most of the 1900s. If you’re with young family members, a free, hands-on art workshop led by artists with activities designed around the current exhibitions is available called Power Plant: Power Kids.
Art Metropole (15-minute drive) is a nonprofit organization with an eclectic collection of merchandise, including a huge selection of artist-created books, periodicals,
By Raysonho @ Open Grid Scheduler / Grid Engine (Own work)
Harbourfront Centreposters, clothing, audio, video, and more. The name is taken from the building’s original tenant, Art Metropole, which operated as one of Toronto’s earliest galleries from 1911 to the 1940s. Art Metropole has always been the leader of Toronto’s artistic community. In 1997, over 13,000 items were transferred to the National Gallery of Canada as the “Art Metropole Collection.” The works of world-renowned artists, such as Yoko Ono, Sol Lewitt, Joseph Beuys, and Marcel Duchamp, are included in the collection.
Daniel Faria Gallery (18-minute drive) is a bright contemporary art space found in a warehouse that used to be an auto body shop. A number of reputable, mostly Canadian, artists’ works are displayed by owner Daniel Faria, including works by Shannon Bool, Chris Curreri, Kristine Moran, and Coupland. Check out other neighboring galleries within walking distance, including Tomorrow Gallery and the artist-run Mercer Union.
Music and Theatre
The Rex Jazz & Blues Bar (6-minute drive) has two to three (mostly free) shows every day, about 19 shows a week, jazz jams on Tuesdays, local and international talent, and a fantastic location. This place is truly hard to beat.
Spend an evening at the Canadian Opera Company (6-minute drive). During the week of CHEST 2017, the COC will be showing The Elixir of Love, a Cinderella story presented with a twist, as a poor and uneducated young man dreams ofwinning the heart of a rich, clever, and beautiful woman.
For a wide variety of events and visual art, visit the Harbourfront Centre (4-minute drive). During your time at CHEST 2017, you’ll find options for literary arts, like the International Festival of Authors, theatre, music, shopping, and more. You may even get a chance for family skating on the Natrel Rink, which opens in November!
Note: all estimated times assume you are starting at the Metro Toronto Convention Centre.The arts and culture of Toronto are sure to inspire you, as will CHEST 2017. When you visit Toronto, October 28 to November 1, you’ll have access to cutting-edge education on pulmonary, critical care, and sleep medicine topics.
Learn more, and register today at chestmeeting.chestnet.org.
Explore the talent of Canadian artists and the culture of Toronto during CHEST Annual Meeting 2017.
Over the last decade, Toronto’s art scene has moved to the former industrial district, creating a new home for galleries, especially those of contemporary art. While Toronto’s galleries may not be very busy outside of opening nights, they allow you to visit at any time and admire the artwork at your own pace. Along with art galleries, there are many options available to experience music and performance art, as well as family-friendly activities. Here are a few places you’ll want to visit:
Art Galleries
The Power Plant (4-minute drive), one of Toronto’s most established contemporary art galleries, is located within Harbourfront in an actual power plant - one that was in operation for most of the 1900s. If you’re with young family members, a free, hands-on art workshop led by artists with activities designed around the current exhibitions is available called Power Plant: Power Kids.
Art Metropole (15-minute drive) is a nonprofit organization with an eclectic collection of merchandise, including a huge selection of artist-created books, periodicals,
By Raysonho @ Open Grid Scheduler / Grid Engine (Own work)
Harbourfront Centreposters, clothing, audio, video, and more. The name is taken from the building’s original tenant, Art Metropole, which operated as one of Toronto’s earliest galleries from 1911 to the 1940s. Art Metropole has always been the leader of Toronto’s artistic community. In 1997, over 13,000 items were transferred to the National Gallery of Canada as the “Art Metropole Collection.” The works of world-renowned artists, such as Yoko Ono, Sol Lewitt, Joseph Beuys, and Marcel Duchamp, are included in the collection.
Daniel Faria Gallery (18-minute drive) is a bright contemporary art space found in a warehouse that used to be an auto body shop. A number of reputable, mostly Canadian, artists’ works are displayed by owner Daniel Faria, including works by Shannon Bool, Chris Curreri, Kristine Moran, and Coupland. Check out other neighboring galleries within walking distance, including Tomorrow Gallery and the artist-run Mercer Union.
Music and Theatre
The Rex Jazz & Blues Bar (6-minute drive) has two to three (mostly free) shows every day, about 19 shows a week, jazz jams on Tuesdays, local and international talent, and a fantastic location. This place is truly hard to beat.
Spend an evening at the Canadian Opera Company (6-minute drive). During the week of CHEST 2017, the COC will be showing The Elixir of Love, a Cinderella story presented with a twist, as a poor and uneducated young man dreams ofwinning the heart of a rich, clever, and beautiful woman.
For a wide variety of events and visual art, visit the Harbourfront Centre (4-minute drive). During your time at CHEST 2017, you’ll find options for literary arts, like the International Festival of Authors, theatre, music, shopping, and more. You may even get a chance for family skating on the Natrel Rink, which opens in November!
Note: all estimated times assume you are starting at the Metro Toronto Convention Centre.The arts and culture of Toronto are sure to inspire you, as will CHEST 2017. When you visit Toronto, October 28 to November 1, you’ll have access to cutting-edge education on pulmonary, critical care, and sleep medicine topics.
Learn more, and register today at chestmeeting.chestnet.org.
Explore the talent of Canadian artists and the culture of Toronto during CHEST Annual Meeting 2017.
Over the last decade, Toronto’s art scene has moved to the former industrial district, creating a new home for galleries, especially those of contemporary art. While Toronto’s galleries may not be very busy outside of opening nights, they allow you to visit at any time and admire the artwork at your own pace. Along with art galleries, there are many options available to experience music and performance art, as well as family-friendly activities. Here are a few places you’ll want to visit:
Art Galleries
The Power Plant (4-minute drive), one of Toronto’s most established contemporary art galleries, is located within Harbourfront in an actual power plant - one that was in operation for most of the 1900s. If you’re with young family members, a free, hands-on art workshop led by artists with activities designed around the current exhibitions is available called Power Plant: Power Kids.
Art Metropole (15-minute drive) is a nonprofit organization with an eclectic collection of merchandise, including a huge selection of artist-created books, periodicals,
By Raysonho @ Open Grid Scheduler / Grid Engine (Own work)
Harbourfront Centreposters, clothing, audio, video, and more. The name is taken from the building’s original tenant, Art Metropole, which operated as one of Toronto’s earliest galleries from 1911 to the 1940s. Art Metropole has always been the leader of Toronto’s artistic community. In 1997, over 13,000 items were transferred to the National Gallery of Canada as the “Art Metropole Collection.” The works of world-renowned artists, such as Yoko Ono, Sol Lewitt, Joseph Beuys, and Marcel Duchamp, are included in the collection.
Daniel Faria Gallery (18-minute drive) is a bright contemporary art space found in a warehouse that used to be an auto body shop. A number of reputable, mostly Canadian, artists’ works are displayed by owner Daniel Faria, including works by Shannon Bool, Chris Curreri, Kristine Moran, and Coupland. Check out other neighboring galleries within walking distance, including Tomorrow Gallery and the artist-run Mercer Union.
Music and Theatre
The Rex Jazz & Blues Bar (6-minute drive) has two to three (mostly free) shows every day, about 19 shows a week, jazz jams on Tuesdays, local and international talent, and a fantastic location. This place is truly hard to beat.
Spend an evening at the Canadian Opera Company (6-minute drive). During the week of CHEST 2017, the COC will be showing The Elixir of Love, a Cinderella story presented with a twist, as a poor and uneducated young man dreams ofwinning the heart of a rich, clever, and beautiful woman.
For a wide variety of events and visual art, visit the Harbourfront Centre (4-minute drive). During your time at CHEST 2017, you’ll find options for literary arts, like the International Festival of Authors, theatre, music, shopping, and more. You may even get a chance for family skating on the Natrel Rink, which opens in November!
Note: all estimated times assume you are starting at the Metro Toronto Convention Centre.The arts and culture of Toronto are sure to inspire you, as will CHEST 2017. When you visit Toronto, October 28 to November 1, you’ll have access to cutting-edge education on pulmonary, critical care, and sleep medicine topics.
Learn more, and register today at chestmeeting.chestnet.org.
Allogeneic Human Mesenchymal Stem Cells in Patients With Idiopathic Pulmonary Fibrosis via Intravenous Delivery (AETHER): A Phase I Safety Clinical Trial. By Dr. M. K. Glassberg et al.
Adult Patients With Bronchiectasis: A First Look at the US Bronchiectasis Research Registry. By Dr. T. R. Aksamit et al.
Variation of Ciliary Beat Pattern in Three Different Beating Planes in Healthy Subjects. By Dr. C. Kempeneers et al.
Evidence-Based Medicine
Interventional Pulmonology Fellowship Accreditation Standards: Executive Summary of the Multisociety Interventional Pulmonology Fellowship Accreditation Committee. By Dr. J. J. Mullon et al.
Giantsin Chest Medicine
Talmadge E. King Jr., MD, FCCP. By Dr. Harold R. Collard.
Allogeneic Human Mesenchymal Stem Cells in Patients With Idiopathic Pulmonary Fibrosis via Intravenous Delivery (AETHER): A Phase I Safety Clinical Trial. By Dr. M. K. Glassberg et al.
Adult Patients With Bronchiectasis: A First Look at the US Bronchiectasis Research Registry. By Dr. T. R. Aksamit et al.
Variation of Ciliary Beat Pattern in Three Different Beating Planes in Healthy Subjects. By Dr. C. Kempeneers et al.
Evidence-Based Medicine
Interventional Pulmonology Fellowship Accreditation Standards: Executive Summary of the Multisociety Interventional Pulmonology Fellowship Accreditation Committee. By Dr. J. J. Mullon et al.
Giantsin Chest Medicine
Talmadge E. King Jr., MD, FCCP. By Dr. Harold R. Collard.
Original Research
Allogeneic Human Mesenchymal Stem Cells in Patients With Idiopathic Pulmonary Fibrosis via Intravenous Delivery (AETHER): A Phase I Safety Clinical Trial. By Dr. M. K. Glassberg et al.
Adult Patients With Bronchiectasis: A First Look at the US Bronchiectasis Research Registry. By Dr. T. R. Aksamit et al.
Variation of Ciliary Beat Pattern in Three Different Beating Planes in Healthy Subjects. By Dr. C. Kempeneers et al.
Evidence-Based Medicine
Interventional Pulmonology Fellowship Accreditation Standards: Executive Summary of the Multisociety Interventional Pulmonology Fellowship Accreditation Committee. By Dr. J. J. Mullon et al.
Giantsin Chest Medicine
Talmadge E. King Jr., MD, FCCP. By Dr. Harold R. Collard.
Update: 8th ed IASLC lung cancer staging guidelines
The new 8th edition guidelines on the staging of non-small cell lung cancer sponsored by the International Association for the Study of Lung Cancer (IASLC), and developed jointly by the American Joint Committee on Cancer and the Union Internationale Contre le Cancer were enacted January 1, 2017, and provide a methodologically rigorous update to staging nomenclature (Detterbeck et al. Chest. 2017;151[1]:193). The new guidelines were developed using a database comprising 94,708 patients in 16 countries, integrating clinical, pathologic, and survival data with multivariate analysis to establish prognostically significant staging subgroups.
In the new guidelines, tumor size has been divided into 1-cm increments for T classifications with new subcategories of T1a <1 cm, T1b 1-2 cm, and T1c 2-3 cm (Rami-Porta et al. J Thorac Oncol. 2015;10[7]:990). Furthermore, T2 has been broadened to include main bronchus tumors causing lobar or whole lung atelectasis extending to the hilum. Tumors with diaphragmatic involvement have been reclassified as T4. Guidance on heterogeneous nodules has also been provided, with emphasis on measurement of the solid component (based on imaging) or depth of invasion (on pathology) to determine T classification.
The N classification remains unchanged from the 7th edition. Exploratory analysis suggested prognostic significance to the number of involved N1/N2 lymph nodes; however, this requires detailed pathologic assessment and was not adopted as a staging criterion (Asamura et al. J Thorac Oncol. 2015;10[12]:1675).
Classification of metastatic disease has been modified from M1a/M1b to M1a for thoracic metastasis, M1b for single/oligometastatic extrathoracic metastasis, and the new category M1c for multiple/disseminated metastases. M1c involvement now denotes stage IVb disease, with lower survival compared to IVa disease (0% vs 10% 5-year survival (Goldstraw et al. J Thorac Oncol. 2015;11[1]:39). Application in broader cohorts, including patients undergoing bronchoscopic staging, will be needed to further validate the new guidelines.
Vivek Murthy, MD
Fellow-in-Training MemberSteering Committee
Pulmonary Physiology, Function, and Rehabilitation
6-minute walk test
The 6-minute walk test (6MWT) is a widely used measure of functional status and exercise capacity. Though it does not diagnose specific etiologies of impairment, the 6MWT provides an assessment of the overall integrated physiologic responses to exercise (Am J Respir Crit Care Med. 2002;166[1]:111). The test is a self-paced, submaximal study. Patients are instructed to “walk as far as possible for 6 minutes” with this distance (6MWD) measured as the primary outcome. 6MWD is associated with clinical outcomes in many cardiopulmonary disorders and is reliable, valid, and responsive to treatment. Normative equations provide predicted and lower limit of normal values (Singh et al. Eur Respir J. 2014;44[6]:1447). In addition to patient comorbidities, several important factors impact 6MWD interpretation. Standardization of the testing course, patient instructions, encouragement, technician assistance, walking aids, and supplemental oxygen use are important in reducing testing variability (Holland et al. Eur Respir J. 2014;44[6]:1428). A significant learning effect exists during the first several walks. An improvement of about 26 m (range 24-29 m) has been reported in patients with COPD, with the majority improving during the second test despite a short time interval lapse. Assessing for longitudinal change in serial testing is based on the minimal clinically important difference (MCID). This represents the difference in 6MWD that is perceived as important to the patient or leads to change in management. Techniques to develop these estimates are based upon statistical analysis of study sample data (distribution-based) or changes in a different, but related, clinical variable that is used as a reference (anchor-based). While minor differences in MCID are reported based on specific disease processes, a European Respiratory Society/American Thoracic Society review based on data from patients with COPD, ILD, and PAH found a MCID value of about 30 m (range 25-33 m) for adults with chronic respiratory disease, independent of specific disease, which is only slightly larger than the short term variability (Puente-Maestu et al. Eur Respir J. 2016;47[2]:429). Knowledge of these factors can assist in proper interpretation of the 6MWT.
Lana Alghothani, MD
NetWork Member
Nitin Bhatt, MD
Steering Committee Member
Pulmonary Vascular Disease
Methamphetamine-associated pulmonary hypertension (MAPAH): “tip of the iceberg”
Pulmonary hypertension (PH) is a devastating condition with serious morbidity and mortality. The Evian Classification and more recent revisions (J Am Coll Cardiol. 2013;62(25 Suppl ):D34) reclassified PH into five subgroups based upon etio-pathogenesis. Group I PH (pulmonary arterial hypertension, PAH) represents a growing list of entities, with Drugs & Toxins (Group 1.3) as a separate subgroup. This subgroup was first recognized following the discovery of an association between PH and the ingestion of the anorexigen aminorex (Gurtner HP. Schweiz Med Wochenschr. 1985;115[24]:818).
Methamphetamine (ME) as a potential etiology for PAH was first reported in 1993 (Schaiberger et al. Chest. 1993;104[2]:614). More recently, Chin et al suggested an association between stimulant use and PAH in 28.9% of their patients diagnosed with idiopathic PAH (Chest. 2006;130[6]:1657). The growing body of evidence linking ME to PAH resulted in upgrading of ME from “Possible” to “Likely” in the latest revision of the PH classification.
Recent gene sequencing data showed carboxylesterase-1, an enzyme that protects against ME-mediated pulmonary vascular injury, may be downregulated in patients with methamphetamine-associated PAH (MAPAH) (Perez et al. Am J Respir Crit Care Med. 193;2016:A2912). Furthermore, amphetamines promote mitochondrial dysfunction and DNA damage in pulmonary hypertension (Chen PI. JCI Insight. 2017;2[2]:e90427). Importantly, Barnett et al demonstrated a poorer prognosis in MAPAH compared with individuals with idiopathic PAH, but they are less likely to be treated with infused prostanoid therapies (Circulation. 2012;126:A13817).
Amphetamine-type stimulants have become the second most widely used class of illicit drugs worldwide (United Nations Office on Drugs & Crime. World Drug Report 2012). An estimated 4.7 million Americans (2.1% of the US population) have tried MA at some time in their lives (J Psychoactive Drugs. 2000;32[2]:137). The true incidence and prevalence of MAPAH remains unknown. One can surmise that with the widespread use of ME, we are only witnessing the “tip of the iceberg.”
Vijay Balasubramanian, MD, FCCP
Steering Committee Member
Franck Rahaghi, MD, FCCP
NetWork Member
Thoracic Oncology
Immunotherapy for lung cancer
The management of non-small cell lung cancer has traditionally focused on surgical resection of early and limited stage tumors and radiation and cytotoxic chemotherapy for patients with advanced disease. Recent progress in the management of patients with metastatic lung cancer treatment has concentrated on the precise histologic diagnosis and the characterization of molecular drivers of malignant progression. Distinguishing small cell from non-small cell carcinomas, as well as differentiating adenocarcinoma from squamous cell carcinomas, enables clinicians to more effectively tailor appropriate chemotherapy. The identification of molecular mutations in EGFR (epidermal growth factor receptor) or fusions in ELM4-ALK translocations as drivers of the malignant process has facilitated tumor regression by targeting the molecular pathways with small molecular inhibitors (tyrosine-kinase inhibitors) or synthetic antibodies. Unfortunately, not all lung cancers carry activating mutations, and those that do may develop resistance to this molecular-targeted approach and show tumor progression.
Immunotherapy, an anticancer therapeutic approach that activates the host immune system to target the tumor, has historically been either a broad spectrum management utilizing immune cytokine modifiers to augment host immune activity or a directed adaptive recruitment and stimulation of host lymphocytes to attack targeted tumor cells. More recently, immunotherapy has taken a targeted molecular approach to modify immune checkpoint inhibitory pathways, the “brakes” of the immune system that tumor cells have manipulated to evade immune surveillance. Cancer cells may be attacked by activated T cells through the MHC complex and T cell receptor pathways. However, cancer cells that express a checkpoint ligand can deactivate T cells through its checkpoint pathway. Cancer cells may evade immune recognition by signaling inhibitory checkpoint receptor pathways, such as PD-1/PDL-1, or CTLA-4 receptors. Blocking the checkpoint inhibition may reactivate the immune response and enhance host immune recognition and killing of tumor cells. Infusions containing FDA-approved nivolumab (Opdivo) and pembrolizumab (Keytruda) block the PD-1 receptor checkpoint, whereas atezolizumab (Tecentriq) blocks PD-L1, the ligand that binds PD-1. These immune therapeutic approaches have been successfully utilized in a variety of solid tumors, including lung cancer and malignant melanomas. Impressive clinical results of prolonged tumor regression have been demonstrated in second-line immunotherapy with improvements over chemotherapy; newer immunotherapy trials have demonstrated efficacy in the first-line setting for metastatic disease. Tumors with high PDL-1 expression and high mutational load predict improved immunotherapy outcomes. As expected, blocking checkpoint immune inhibition may lead to autoimmune-like conditions of pneumonitis, hepatitis, colitis, and dermatitis. Tumor tissue markers predictive of a therapeutic immune response are in the research phase. Immunotherapy against lung cancer adds to the therapeutic armamentarium of cancer management and provides an exciting new research arena into the biology and immunology of lung cancer.
Arnold M. Schwartz, MD, PhD, FCCP
Steering Committee Member
References
Cousin-Frankel J. Breakthrough of the year 2013: cancer immunotherapy. Science . 2013;342[6165]:1432.
Sharma P, et al. The future of immune checkpoint therapy. Science . 2015;348[6230]:56.
Garon EB, et al. Pembrolizumab for the treatment of non-small cell lung cancer. N Engl J Med . 2015;372[21]:2018.
Brahmer J, et al. Nivolumab versus docetaxel in advanced squamous cell non-small cell lung cancer. N Engl J Med . 2015;373[2]:123.
Reck M, et al. Pembrolizumab versus chemotherapy for PDL-1 positive non-small cell cancer. N Engl J Med . 2016;375[19]:1823. Herbst RS, et al. Pembrolizumab versus docetaxel for previously treated PDL-1- positive advanced non-small cell lung cancer. Lancet . 2016;387[10027]:1540.
Update: 8th ed IASLC lung cancer staging guidelines
The new 8th edition guidelines on the staging of non-small cell lung cancer sponsored by the International Association for the Study of Lung Cancer (IASLC), and developed jointly by the American Joint Committee on Cancer and the Union Internationale Contre le Cancer were enacted January 1, 2017, and provide a methodologically rigorous update to staging nomenclature (Detterbeck et al. Chest. 2017;151[1]:193). The new guidelines were developed using a database comprising 94,708 patients in 16 countries, integrating clinical, pathologic, and survival data with multivariate analysis to establish prognostically significant staging subgroups.
In the new guidelines, tumor size has been divided into 1-cm increments for T classifications with new subcategories of T1a <1 cm, T1b 1-2 cm, and T1c 2-3 cm (Rami-Porta et al. J Thorac Oncol. 2015;10[7]:990). Furthermore, T2 has been broadened to include main bronchus tumors causing lobar or whole lung atelectasis extending to the hilum. Tumors with diaphragmatic involvement have been reclassified as T4. Guidance on heterogeneous nodules has also been provided, with emphasis on measurement of the solid component (based on imaging) or depth of invasion (on pathology) to determine T classification.
The N classification remains unchanged from the 7th edition. Exploratory analysis suggested prognostic significance to the number of involved N1/N2 lymph nodes; however, this requires detailed pathologic assessment and was not adopted as a staging criterion (Asamura et al. J Thorac Oncol. 2015;10[12]:1675).
Classification of metastatic disease has been modified from M1a/M1b to M1a for thoracic metastasis, M1b for single/oligometastatic extrathoracic metastasis, and the new category M1c for multiple/disseminated metastases. M1c involvement now denotes stage IVb disease, with lower survival compared to IVa disease (0% vs 10% 5-year survival (Goldstraw et al. J Thorac Oncol. 2015;11[1]:39). Application in broader cohorts, including patients undergoing bronchoscopic staging, will be needed to further validate the new guidelines.
Vivek Murthy, MD
Fellow-in-Training MemberSteering Committee
Pulmonary Physiology, Function, and Rehabilitation
6-minute walk test
The 6-minute walk test (6MWT) is a widely used measure of functional status and exercise capacity. Though it does not diagnose specific etiologies of impairment, the 6MWT provides an assessment of the overall integrated physiologic responses to exercise (Am J Respir Crit Care Med. 2002;166[1]:111). The test is a self-paced, submaximal study. Patients are instructed to “walk as far as possible for 6 minutes” with this distance (6MWD) measured as the primary outcome. 6MWD is associated with clinical outcomes in many cardiopulmonary disorders and is reliable, valid, and responsive to treatment. Normative equations provide predicted and lower limit of normal values (Singh et al. Eur Respir J. 2014;44[6]:1447). In addition to patient comorbidities, several important factors impact 6MWD interpretation. Standardization of the testing course, patient instructions, encouragement, technician assistance, walking aids, and supplemental oxygen use are important in reducing testing variability (Holland et al. Eur Respir J. 2014;44[6]:1428). A significant learning effect exists during the first several walks. An improvement of about 26 m (range 24-29 m) has been reported in patients with COPD, with the majority improving during the second test despite a short time interval lapse. Assessing for longitudinal change in serial testing is based on the minimal clinically important difference (MCID). This represents the difference in 6MWD that is perceived as important to the patient or leads to change in management. Techniques to develop these estimates are based upon statistical analysis of study sample data (distribution-based) or changes in a different, but related, clinical variable that is used as a reference (anchor-based). While minor differences in MCID are reported based on specific disease processes, a European Respiratory Society/American Thoracic Society review based on data from patients with COPD, ILD, and PAH found a MCID value of about 30 m (range 25-33 m) for adults with chronic respiratory disease, independent of specific disease, which is only slightly larger than the short term variability (Puente-Maestu et al. Eur Respir J. 2016;47[2]:429). Knowledge of these factors can assist in proper interpretation of the 6MWT.
Lana Alghothani, MD
NetWork Member
Nitin Bhatt, MD
Steering Committee Member
Pulmonary Vascular Disease
Methamphetamine-associated pulmonary hypertension (MAPAH): “tip of the iceberg”
Pulmonary hypertension (PH) is a devastating condition with serious morbidity and mortality. The Evian Classification and more recent revisions (J Am Coll Cardiol. 2013;62(25 Suppl ):D34) reclassified PH into five subgroups based upon etio-pathogenesis. Group I PH (pulmonary arterial hypertension, PAH) represents a growing list of entities, with Drugs & Toxins (Group 1.3) as a separate subgroup. This subgroup was first recognized following the discovery of an association between PH and the ingestion of the anorexigen aminorex (Gurtner HP. Schweiz Med Wochenschr. 1985;115[24]:818).
Methamphetamine (ME) as a potential etiology for PAH was first reported in 1993 (Schaiberger et al. Chest. 1993;104[2]:614). More recently, Chin et al suggested an association between stimulant use and PAH in 28.9% of their patients diagnosed with idiopathic PAH (Chest. 2006;130[6]:1657). The growing body of evidence linking ME to PAH resulted in upgrading of ME from “Possible” to “Likely” in the latest revision of the PH classification.
Recent gene sequencing data showed carboxylesterase-1, an enzyme that protects against ME-mediated pulmonary vascular injury, may be downregulated in patients with methamphetamine-associated PAH (MAPAH) (Perez et al. Am J Respir Crit Care Med. 193;2016:A2912). Furthermore, amphetamines promote mitochondrial dysfunction and DNA damage in pulmonary hypertension (Chen PI. JCI Insight. 2017;2[2]:e90427). Importantly, Barnett et al demonstrated a poorer prognosis in MAPAH compared with individuals with idiopathic PAH, but they are less likely to be treated with infused prostanoid therapies (Circulation. 2012;126:A13817).
Amphetamine-type stimulants have become the second most widely used class of illicit drugs worldwide (United Nations Office on Drugs & Crime. World Drug Report 2012). An estimated 4.7 million Americans (2.1% of the US population) have tried MA at some time in their lives (J Psychoactive Drugs. 2000;32[2]:137). The true incidence and prevalence of MAPAH remains unknown. One can surmise that with the widespread use of ME, we are only witnessing the “tip of the iceberg.”
Vijay Balasubramanian, MD, FCCP
Steering Committee Member
Franck Rahaghi, MD, FCCP
NetWork Member
Thoracic Oncology
Immunotherapy for lung cancer
The management of non-small cell lung cancer has traditionally focused on surgical resection of early and limited stage tumors and radiation and cytotoxic chemotherapy for patients with advanced disease. Recent progress in the management of patients with metastatic lung cancer treatment has concentrated on the precise histologic diagnosis and the characterization of molecular drivers of malignant progression. Distinguishing small cell from non-small cell carcinomas, as well as differentiating adenocarcinoma from squamous cell carcinomas, enables clinicians to more effectively tailor appropriate chemotherapy. The identification of molecular mutations in EGFR (epidermal growth factor receptor) or fusions in ELM4-ALK translocations as drivers of the malignant process has facilitated tumor regression by targeting the molecular pathways with small molecular inhibitors (tyrosine-kinase inhibitors) or synthetic antibodies. Unfortunately, not all lung cancers carry activating mutations, and those that do may develop resistance to this molecular-targeted approach and show tumor progression.
Immunotherapy, an anticancer therapeutic approach that activates the host immune system to target the tumor, has historically been either a broad spectrum management utilizing immune cytokine modifiers to augment host immune activity or a directed adaptive recruitment and stimulation of host lymphocytes to attack targeted tumor cells. More recently, immunotherapy has taken a targeted molecular approach to modify immune checkpoint inhibitory pathways, the “brakes” of the immune system that tumor cells have manipulated to evade immune surveillance. Cancer cells may be attacked by activated T cells through the MHC complex and T cell receptor pathways. However, cancer cells that express a checkpoint ligand can deactivate T cells through its checkpoint pathway. Cancer cells may evade immune recognition by signaling inhibitory checkpoint receptor pathways, such as PD-1/PDL-1, or CTLA-4 receptors. Blocking the checkpoint inhibition may reactivate the immune response and enhance host immune recognition and killing of tumor cells. Infusions containing FDA-approved nivolumab (Opdivo) and pembrolizumab (Keytruda) block the PD-1 receptor checkpoint, whereas atezolizumab (Tecentriq) blocks PD-L1, the ligand that binds PD-1. These immune therapeutic approaches have been successfully utilized in a variety of solid tumors, including lung cancer and malignant melanomas. Impressive clinical results of prolonged tumor regression have been demonstrated in second-line immunotherapy with improvements over chemotherapy; newer immunotherapy trials have demonstrated efficacy in the first-line setting for metastatic disease. Tumors with high PDL-1 expression and high mutational load predict improved immunotherapy outcomes. As expected, blocking checkpoint immune inhibition may lead to autoimmune-like conditions of pneumonitis, hepatitis, colitis, and dermatitis. Tumor tissue markers predictive of a therapeutic immune response are in the research phase. Immunotherapy against lung cancer adds to the therapeutic armamentarium of cancer management and provides an exciting new research arena into the biology and immunology of lung cancer.
Arnold M. Schwartz, MD, PhD, FCCP
Steering Committee Member
References
Cousin-Frankel J. Breakthrough of the year 2013: cancer immunotherapy. Science . 2013;342[6165]:1432.
Sharma P, et al. The future of immune checkpoint therapy. Science . 2015;348[6230]:56.
Garon EB, et al. Pembrolizumab for the treatment of non-small cell lung cancer. N Engl J Med . 2015;372[21]:2018.
Brahmer J, et al. Nivolumab versus docetaxel in advanced squamous cell non-small cell lung cancer. N Engl J Med . 2015;373[2]:123.
Reck M, et al. Pembrolizumab versus chemotherapy for PDL-1 positive non-small cell cancer. N Engl J Med . 2016;375[19]:1823. Herbst RS, et al. Pembrolizumab versus docetaxel for previously treated PDL-1- positive advanced non-small cell lung cancer. Lancet . 2016;387[10027]:1540.
Interventional Chest/Diagnostic Procedures
Update: 8th ed IASLC lung cancer staging guidelines
The new 8th edition guidelines on the staging of non-small cell lung cancer sponsored by the International Association for the Study of Lung Cancer (IASLC), and developed jointly by the American Joint Committee on Cancer and the Union Internationale Contre le Cancer were enacted January 1, 2017, and provide a methodologically rigorous update to staging nomenclature (Detterbeck et al. Chest. 2017;151[1]:193). The new guidelines were developed using a database comprising 94,708 patients in 16 countries, integrating clinical, pathologic, and survival data with multivariate analysis to establish prognostically significant staging subgroups.
In the new guidelines, tumor size has been divided into 1-cm increments for T classifications with new subcategories of T1a <1 cm, T1b 1-2 cm, and T1c 2-3 cm (Rami-Porta et al. J Thorac Oncol. 2015;10[7]:990). Furthermore, T2 has been broadened to include main bronchus tumors causing lobar or whole lung atelectasis extending to the hilum. Tumors with diaphragmatic involvement have been reclassified as T4. Guidance on heterogeneous nodules has also been provided, with emphasis on measurement of the solid component (based on imaging) or depth of invasion (on pathology) to determine T classification.
The N classification remains unchanged from the 7th edition. Exploratory analysis suggested prognostic significance to the number of involved N1/N2 lymph nodes; however, this requires detailed pathologic assessment and was not adopted as a staging criterion (Asamura et al. J Thorac Oncol. 2015;10[12]:1675).
Classification of metastatic disease has been modified from M1a/M1b to M1a for thoracic metastasis, M1b for single/oligometastatic extrathoracic metastasis, and the new category M1c for multiple/disseminated metastases. M1c involvement now denotes stage IVb disease, with lower survival compared to IVa disease (0% vs 10% 5-year survival (Goldstraw et al. J Thorac Oncol. 2015;11[1]:39). Application in broader cohorts, including patients undergoing bronchoscopic staging, will be needed to further validate the new guidelines.
Vivek Murthy, MD
Fellow-in-Training MemberSteering Committee
Pulmonary Physiology, Function, and Rehabilitation
6-minute walk test
The 6-minute walk test (6MWT) is a widely used measure of functional status and exercise capacity. Though it does not diagnose specific etiologies of impairment, the 6MWT provides an assessment of the overall integrated physiologic responses to exercise (Am J Respir Crit Care Med. 2002;166[1]:111). The test is a self-paced, submaximal study. Patients are instructed to “walk as far as possible for 6 minutes” with this distance (6MWD) measured as the primary outcome. 6MWD is associated with clinical outcomes in many cardiopulmonary disorders and is reliable, valid, and responsive to treatment. Normative equations provide predicted and lower limit of normal values (Singh et al. Eur Respir J. 2014;44[6]:1447). In addition to patient comorbidities, several important factors impact 6MWD interpretation. Standardization of the testing course, patient instructions, encouragement, technician assistance, walking aids, and supplemental oxygen use are important in reducing testing variability (Holland et al. Eur Respir J. 2014;44[6]:1428). A significant learning effect exists during the first several walks. An improvement of about 26 m (range 24-29 m) has been reported in patients with COPD, with the majority improving during the second test despite a short time interval lapse. Assessing for longitudinal change in serial testing is based on the minimal clinically important difference (MCID). This represents the difference in 6MWD that is perceived as important to the patient or leads to change in management. Techniques to develop these estimates are based upon statistical analysis of study sample data (distribution-based) or changes in a different, but related, clinical variable that is used as a reference (anchor-based). While minor differences in MCID are reported based on specific disease processes, a European Respiratory Society/American Thoracic Society review based on data from patients with COPD, ILD, and PAH found a MCID value of about 30 m (range 25-33 m) for adults with chronic respiratory disease, independent of specific disease, which is only slightly larger than the short term variability (Puente-Maestu et al. Eur Respir J. 2016;47[2]:429). Knowledge of these factors can assist in proper interpretation of the 6MWT.
Lana Alghothani, MD
NetWork Member
Nitin Bhatt, MD
Steering Committee Member
Pulmonary Vascular Disease
Methamphetamine-associated pulmonary hypertension (MAPAH): “tip of the iceberg”
Pulmonary hypertension (PH) is a devastating condition with serious morbidity and mortality. The Evian Classification and more recent revisions (J Am Coll Cardiol. 2013;62(25 Suppl ):D34) reclassified PH into five subgroups based upon etio-pathogenesis. Group I PH (pulmonary arterial hypertension, PAH) represents a growing list of entities, with Drugs & Toxins (Group 1.3) as a separate subgroup. This subgroup was first recognized following the discovery of an association between PH and the ingestion of the anorexigen aminorex (Gurtner HP. Schweiz Med Wochenschr. 1985;115[24]:818).
Methamphetamine (ME) as a potential etiology for PAH was first reported in 1993 (Schaiberger et al. Chest. 1993;104[2]:614). More recently, Chin et al suggested an association between stimulant use and PAH in 28.9% of their patients diagnosed with idiopathic PAH (Chest. 2006;130[6]:1657). The growing body of evidence linking ME to PAH resulted in upgrading of ME from “Possible” to “Likely” in the latest revision of the PH classification.
Recent gene sequencing data showed carboxylesterase-1, an enzyme that protects against ME-mediated pulmonary vascular injury, may be downregulated in patients with methamphetamine-associated PAH (MAPAH) (Perez et al. Am J Respir Crit Care Med. 193;2016:A2912). Furthermore, amphetamines promote mitochondrial dysfunction and DNA damage in pulmonary hypertension (Chen PI. JCI Insight. 2017;2[2]:e90427). Importantly, Barnett et al demonstrated a poorer prognosis in MAPAH compared with individuals with idiopathic PAH, but they are less likely to be treated with infused prostanoid therapies (Circulation. 2012;126:A13817).
Amphetamine-type stimulants have become the second most widely used class of illicit drugs worldwide (United Nations Office on Drugs & Crime. World Drug Report 2012). An estimated 4.7 million Americans (2.1% of the US population) have tried MA at some time in their lives (J Psychoactive Drugs. 2000;32[2]:137). The true incidence and prevalence of MAPAH remains unknown. One can surmise that with the widespread use of ME, we are only witnessing the “tip of the iceberg.”
Vijay Balasubramanian, MD, FCCP
Steering Committee Member
Franck Rahaghi, MD, FCCP
NetWork Member
Thoracic Oncology
Immunotherapy for lung cancer
The management of non-small cell lung cancer has traditionally focused on surgical resection of early and limited stage tumors and radiation and cytotoxic chemotherapy for patients with advanced disease. Recent progress in the management of patients with metastatic lung cancer treatment has concentrated on the precise histologic diagnosis and the characterization of molecular drivers of malignant progression. Distinguishing small cell from non-small cell carcinomas, as well as differentiating adenocarcinoma from squamous cell carcinomas, enables clinicians to more effectively tailor appropriate chemotherapy. The identification of molecular mutations in EGFR (epidermal growth factor receptor) or fusions in ELM4-ALK translocations as drivers of the malignant process has facilitated tumor regression by targeting the molecular pathways with small molecular inhibitors (tyrosine-kinase inhibitors) or synthetic antibodies. Unfortunately, not all lung cancers carry activating mutations, and those that do may develop resistance to this molecular-targeted approach and show tumor progression.
Immunotherapy, an anticancer therapeutic approach that activates the host immune system to target the tumor, has historically been either a broad spectrum management utilizing immune cytokine modifiers to augment host immune activity or a directed adaptive recruitment and stimulation of host lymphocytes to attack targeted tumor cells. More recently, immunotherapy has taken a targeted molecular approach to modify immune checkpoint inhibitory pathways, the “brakes” of the immune system that tumor cells have manipulated to evade immune surveillance. Cancer cells may be attacked by activated T cells through the MHC complex and T cell receptor pathways. However, cancer cells that express a checkpoint ligand can deactivate T cells through its checkpoint pathway. Cancer cells may evade immune recognition by signaling inhibitory checkpoint receptor pathways, such as PD-1/PDL-1, or CTLA-4 receptors. Blocking the checkpoint inhibition may reactivate the immune response and enhance host immune recognition and killing of tumor cells. Infusions containing FDA-approved nivolumab (Opdivo) and pembrolizumab (Keytruda) block the PD-1 receptor checkpoint, whereas atezolizumab (Tecentriq) blocks PD-L1, the ligand that binds PD-1. These immune therapeutic approaches have been successfully utilized in a variety of solid tumors, including lung cancer and malignant melanomas. Impressive clinical results of prolonged tumor regression have been demonstrated in second-line immunotherapy with improvements over chemotherapy; newer immunotherapy trials have demonstrated efficacy in the first-line setting for metastatic disease. Tumors with high PDL-1 expression and high mutational load predict improved immunotherapy outcomes. As expected, blocking checkpoint immune inhibition may lead to autoimmune-like conditions of pneumonitis, hepatitis, colitis, and dermatitis. Tumor tissue markers predictive of a therapeutic immune response are in the research phase. Immunotherapy against lung cancer adds to the therapeutic armamentarium of cancer management and provides an exciting new research arena into the biology and immunology of lung cancer.
Arnold M. Schwartz, MD, PhD, FCCP
Steering Committee Member
References
Cousin-Frankel J. Breakthrough of the year 2013: cancer immunotherapy. Science . 2013;342[6165]:1432.
Sharma P, et al. The future of immune checkpoint therapy. Science . 2015;348[6230]:56.
Garon EB, et al. Pembrolizumab for the treatment of non-small cell lung cancer. N Engl J Med . 2015;372[21]:2018.
Brahmer J, et al. Nivolumab versus docetaxel in advanced squamous cell non-small cell lung cancer. N Engl J Med . 2015;373[2]:123.
Reck M, et al. Pembrolizumab versus chemotherapy for PDL-1 positive non-small cell cancer. N Engl J Med . 2016;375[19]:1823. Herbst RS, et al. Pembrolizumab versus docetaxel for previously treated PDL-1- positive advanced non-small cell lung cancer. Lancet . 2016;387[10027]:1540.
Where are they now? What have they been up to? CHEST’s Past Presidents each forged the way for the many successes of the American College of Chest Physicians, leading to enhanced patient care around the globe. Their outstanding leadership and vision are evidenced today in many of CHEST’s strategic initiatives. Let’s check in with our first woman President, Dr. Deborah Shure.
Deborah Shure, MD, Master FCCP
President 1995-1996
When I began my year as President of the American College of Chest Physicians in 1995 in New York City, I became the first woman to serve in that role in the then 60-year history of the College. One major theme for my presidential year was inclusiveness. With the support of the Regents and the members of the College, we sought to increase the roles of our International Fellows and Affiliate Members, as well as the participation of all of our FCCPs. We also expanded the role of the College in global tobacco control.
Dr. Deborah Shure
With a focus on these goals, the presidential year was truly an exciting and fulfilling one. I was honored to meet so many members worldwide and, through the College, enable the support of regional meetings internationally. Our efforts in the Asia-Pacific area lent essential support to one of the early conferences on tobacco control in the Philippines (Asia Pacific Conference on Control of Tobacco, Subic, Philippines, 1998). My presentation in 1996 in Bangkok was the College’s first International Partnering for World Health Award to H.M. King Bhumibol of Thailand for his work in the prevention and treatment of chest diseases in Thailand, was an unforgettable experience.
My presidential year ended in San Francisco. Since that time, my professional life has been varied and interesting. I was fortunate to continue my academic career encompassing both clinical and basic research. In 2005, I tried a new path and worked for the FDA Center for Devices and Radiological Health, using my background in device development (the angioscope) and clinical trials. Since 2012, I have been using my clinical, academic, and regulatory experience as an independent consultant in clinical trial design.
On a personal note, my partner of many years, Aymarah Robles, MD, FCCP, and I were finally able to marry in January 2015. So, we are now a happy and official two pulmonary, Cuban-American household enjoying the culture of Little Havana and the many outdoor activities of Miami!
Where are they now? What have they been up to? CHEST’s Past Presidents each forged the way for the many successes of the American College of Chest Physicians, leading to enhanced patient care around the globe. Their outstanding leadership and vision are evidenced today in many of CHEST’s strategic initiatives. Let’s check in with our first woman President, Dr. Deborah Shure.
Deborah Shure, MD, Master FCCP
President 1995-1996
When I began my year as President of the American College of Chest Physicians in 1995 in New York City, I became the first woman to serve in that role in the then 60-year history of the College. One major theme for my presidential year was inclusiveness. With the support of the Regents and the members of the College, we sought to increase the roles of our International Fellows and Affiliate Members, as well as the participation of all of our FCCPs. We also expanded the role of the College in global tobacco control.
Dr. Deborah Shure
With a focus on these goals, the presidential year was truly an exciting and fulfilling one. I was honored to meet so many members worldwide and, through the College, enable the support of regional meetings internationally. Our efforts in the Asia-Pacific area lent essential support to one of the early conferences on tobacco control in the Philippines (Asia Pacific Conference on Control of Tobacco, Subic, Philippines, 1998). My presentation in 1996 in Bangkok was the College’s first International Partnering for World Health Award to H.M. King Bhumibol of Thailand for his work in the prevention and treatment of chest diseases in Thailand, was an unforgettable experience.
My presidential year ended in San Francisco. Since that time, my professional life has been varied and interesting. I was fortunate to continue my academic career encompassing both clinical and basic research. In 2005, I tried a new path and worked for the FDA Center for Devices and Radiological Health, using my background in device development (the angioscope) and clinical trials. Since 2012, I have been using my clinical, academic, and regulatory experience as an independent consultant in clinical trial design.
On a personal note, my partner of many years, Aymarah Robles, MD, FCCP, and I were finally able to marry in January 2015. So, we are now a happy and official two pulmonary, Cuban-American household enjoying the culture of Little Havana and the many outdoor activities of Miami!
Where are they now? What have they been up to? CHEST’s Past Presidents each forged the way for the many successes of the American College of Chest Physicians, leading to enhanced patient care around the globe. Their outstanding leadership and vision are evidenced today in many of CHEST’s strategic initiatives. Let’s check in with our first woman President, Dr. Deborah Shure.
Deborah Shure, MD, Master FCCP
President 1995-1996
When I began my year as President of the American College of Chest Physicians in 1995 in New York City, I became the first woman to serve in that role in the then 60-year history of the College. One major theme for my presidential year was inclusiveness. With the support of the Regents and the members of the College, we sought to increase the roles of our International Fellows and Affiliate Members, as well as the participation of all of our FCCPs. We also expanded the role of the College in global tobacco control.
Dr. Deborah Shure
With a focus on these goals, the presidential year was truly an exciting and fulfilling one. I was honored to meet so many members worldwide and, through the College, enable the support of regional meetings internationally. Our efforts in the Asia-Pacific area lent essential support to one of the early conferences on tobacco control in the Philippines (Asia Pacific Conference on Control of Tobacco, Subic, Philippines, 1998). My presentation in 1996 in Bangkok was the College’s first International Partnering for World Health Award to H.M. King Bhumibol of Thailand for his work in the prevention and treatment of chest diseases in Thailand, was an unforgettable experience.
My presidential year ended in San Francisco. Since that time, my professional life has been varied and interesting. I was fortunate to continue my academic career encompassing both clinical and basic research. In 2005, I tried a new path and worked for the FDA Center for Devices and Radiological Health, using my background in device development (the angioscope) and clinical trials. Since 2012, I have been using my clinical, academic, and regulatory experience as an independent consultant in clinical trial design.
On a personal note, my partner of many years, Aymarah Robles, MD, FCCP, and I were finally able to marry in January 2015. So, we are now a happy and official two pulmonary, Cuban-American household enjoying the culture of Little Havana and the many outdoor activities of Miami!
SVS Past President Peter Gloviczki, MD, will perform his award-winning magic as the special guest at the SVS Political Action Committee (PAC) reception during the Vascular Annual Meeting.
All SVS members who have contributed to the PAC since January 2016 – including those who donate during VAM ‘17 -- are invited.
(The SVS PAC booth will be located outside the hall hosting the plenary sessions.)
Contributions can be made by mail with a personal check using the PAC donation form [PDF] or by credit/debit card at www.vascular.org/pac-donation. All SVS members who contribute to the PAC will receive pins, be recognized at the 2017 VAM and in the PAC Annual Report, in addition to being invited to the reception.
Dr. Peter Gloviczki
All PAC contributions are used to gain access to Congressional members and non-incumbent candidates in both political parties who make decisions about our issues. Although SVS has achieved many legislative victories, such as the repeal of the Sustainable Growth Rate formula that determined Medicare reimbursement, we have important issues to support/oppose. These include repealing the Independent Payment Advisory Board and preventing Medicare and imaging cuts.
SVS Past President Peter Gloviczki, MD, will perform his award-winning magic as the special guest at the SVS Political Action Committee (PAC) reception during the Vascular Annual Meeting.
All SVS members who have contributed to the PAC since January 2016 – including those who donate during VAM ‘17 -- are invited.
(The SVS PAC booth will be located outside the hall hosting the plenary sessions.)
Contributions can be made by mail with a personal check using the PAC donation form [PDF] or by credit/debit card at www.vascular.org/pac-donation. All SVS members who contribute to the PAC will receive pins, be recognized at the 2017 VAM and in the PAC Annual Report, in addition to being invited to the reception.
Dr. Peter Gloviczki
All PAC contributions are used to gain access to Congressional members and non-incumbent candidates in both political parties who make decisions about our issues. Although SVS has achieved many legislative victories, such as the repeal of the Sustainable Growth Rate formula that determined Medicare reimbursement, we have important issues to support/oppose. These include repealing the Independent Payment Advisory Board and preventing Medicare and imaging cuts.
SVS Past President Peter Gloviczki, MD, will perform his award-winning magic as the special guest at the SVS Political Action Committee (PAC) reception during the Vascular Annual Meeting.
All SVS members who have contributed to the PAC since January 2016 – including those who donate during VAM ‘17 -- are invited.
(The SVS PAC booth will be located outside the hall hosting the plenary sessions.)
Contributions can be made by mail with a personal check using the PAC donation form [PDF] or by credit/debit card at www.vascular.org/pac-donation. All SVS members who contribute to the PAC will receive pins, be recognized at the 2017 VAM and in the PAC Annual Report, in addition to being invited to the reception.
Dr. Peter Gloviczki
All PAC contributions are used to gain access to Congressional members and non-incumbent candidates in both political parties who make decisions about our issues. Although SVS has achieved many legislative victories, such as the repeal of the Sustainable Growth Rate formula that determined Medicare reimbursement, we have important issues to support/oppose. These include repealing the Independent Payment Advisory Board and preventing Medicare and imaging cuts.
VAM17 promises to keep you busy. Don't miss a moment. If you miss an event in your schedule, you can "attend" almost 400 individual presentations later by buying the On-Demand Library, featuring VAM PowerPoint slides, audio and a selection of videotaped sessions, all for the pre-event price of $99. The cost will increase after VAM ends.
VAM17 promises to keep you busy. Don't miss a moment. If you miss an event in your schedule, you can "attend" almost 400 individual presentations later by buying the On-Demand Library, featuring VAM PowerPoint slides, audio and a selection of videotaped sessions, all for the pre-event price of $99. The cost will increase after VAM ends.
VAM17 promises to keep you busy. Don't miss a moment. If you miss an event in your schedule, you can "attend" almost 400 individual presentations later by buying the On-Demand Library, featuring VAM PowerPoint slides, audio and a selection of videotaped sessions, all for the pre-event price of $99. The cost will increase after VAM ends.
This year’s Vascular Annual Meeting includes an important final-day summit on a number of factors in thoracoabdominal aneurysms and aortic disease.
The Society of Thoracic Surgeons is co-hosting the SVS/STS Summit, "Advances and Controversies in the Management of Complex Thoracoabdominal Aneurysmal Disease and Type B Aortic Dissection,” set for 1:30 to 5:15 p.m. Saturday, June 3.
Attendeeswill learn the technical aspects of both open and endovascular repair of thoracoabdominal aneurysms, to compare and contrast options for preservation of spinal cord function and identify current and future treatment options in the arena of Thoracic Endovascular Aneurysm Repair (TEVAR), focusing on aortic dissection.
The summit includes:
A debate on the merits of medical versus endovascular treatment of uncomplicated dissections
Training future cardiovascular surgeons to manage complex aortic disease
Why thoracic and vascular surgeons will need to work together as open and endovascular experts to manage complex aortic disease
Sign up for the summit while registering for VAM. If you have already registered, simply return to the registration page and add the summit separately.
This year’s Vascular Annual Meeting includes an important final-day summit on a number of factors in thoracoabdominal aneurysms and aortic disease.
The Society of Thoracic Surgeons is co-hosting the SVS/STS Summit, "Advances and Controversies in the Management of Complex Thoracoabdominal Aneurysmal Disease and Type B Aortic Dissection,” set for 1:30 to 5:15 p.m. Saturday, June 3.
Attendeeswill learn the technical aspects of both open and endovascular repair of thoracoabdominal aneurysms, to compare and contrast options for preservation of spinal cord function and identify current and future treatment options in the arena of Thoracic Endovascular Aneurysm Repair (TEVAR), focusing on aortic dissection.
The summit includes:
A debate on the merits of medical versus endovascular treatment of uncomplicated dissections
Training future cardiovascular surgeons to manage complex aortic disease
Why thoracic and vascular surgeons will need to work together as open and endovascular experts to manage complex aortic disease
Sign up for the summit while registering for VAM. If you have already registered, simply return to the registration page and add the summit separately.
This year’s Vascular Annual Meeting includes an important final-day summit on a number of factors in thoracoabdominal aneurysms and aortic disease.
The Society of Thoracic Surgeons is co-hosting the SVS/STS Summit, "Advances and Controversies in the Management of Complex Thoracoabdominal Aneurysmal Disease and Type B Aortic Dissection,” set for 1:30 to 5:15 p.m. Saturday, June 3.
Attendeeswill learn the technical aspects of both open and endovascular repair of thoracoabdominal aneurysms, to compare and contrast options for preservation of spinal cord function and identify current and future treatment options in the arena of Thoracic Endovascular Aneurysm Repair (TEVAR), focusing on aortic dissection.
The summit includes:
A debate on the merits of medical versus endovascular treatment of uncomplicated dissections
Training future cardiovascular surgeons to manage complex aortic disease
Why thoracic and vascular surgeons will need to work together as open and endovascular experts to manage complex aortic disease
Sign up for the summit while registering for VAM. If you have already registered, simply return to the registration page and add the summit separately.
The one-day meeting emphasizes emerging vascular science. It is considered a key event for meeting and reconnecting with vascular research collaborators.
New this year is the Alexander W. Clowes Distinguished Lecture, honoring the legacy of vascular surgeon-scientist Alec Clowes, M.D. William Sessa, Ph.D., of Yale University School of Medicine, will deliver the inaugural lecture, titled, "New Insights in Arteriogenesis and Blood Flow Control." The translational panel will discuss "Matrix Revolution: Vascular Repair and Regeneration," in a session co-sponsored with the International Society for Applied Cardiovascular Biology.
Four abstract sessions will focus on vascular endothelium and thrombosis, aortic and arterial pathology, stem cells and tissue engineering, and peripheral arterial disease. See the full program here.
The one-day meeting emphasizes emerging vascular science. It is considered a key event for meeting and reconnecting with vascular research collaborators.
New this year is the Alexander W. Clowes Distinguished Lecture, honoring the legacy of vascular surgeon-scientist Alec Clowes, M.D. William Sessa, Ph.D., of Yale University School of Medicine, will deliver the inaugural lecture, titled, "New Insights in Arteriogenesis and Blood Flow Control." The translational panel will discuss "Matrix Revolution: Vascular Repair and Regeneration," in a session co-sponsored with the International Society for Applied Cardiovascular Biology.
Four abstract sessions will focus on vascular endothelium and thrombosis, aortic and arterial pathology, stem cells and tissue engineering, and peripheral arterial disease. See the full program here.
The one-day meeting emphasizes emerging vascular science. It is considered a key event for meeting and reconnecting with vascular research collaborators.
New this year is the Alexander W. Clowes Distinguished Lecture, honoring the legacy of vascular surgeon-scientist Alec Clowes, M.D. William Sessa, Ph.D., of Yale University School of Medicine, will deliver the inaugural lecture, titled, "New Insights in Arteriogenesis and Blood Flow Control." The translational panel will discuss "Matrix Revolution: Vascular Repair and Regeneration," in a session co-sponsored with the International Society for Applied Cardiovascular Biology.
Four abstract sessions will focus on vascular endothelium and thrombosis, aortic and arterial pathology, stem cells and tissue engineering, and peripheral arterial disease. See the full program here.
Don't forget you can take the Vascular Annual Meeting home with you! You can pre-purchase all VAM PowerPoint slides, audio and a limited selection of assorted videotaped sessions in the On-Demand Library. Purchase price through the conclusion of VAM (5 p.m. Saturday, June 3) is just $99.
This valuable resource of almost 400 individual presentations will be available shortly following the meeting’s conclusion, with access continued for up to one year.
The cost increases for VAM attendees after the meeting’s to $199, so buy now and save. For those who have already registered and now want to add the On-Demand Library, simply return to the registration page and add the library separately.
Don't forget you can take the Vascular Annual Meeting home with you! You can pre-purchase all VAM PowerPoint slides, audio and a limited selection of assorted videotaped sessions in the On-Demand Library. Purchase price through the conclusion of VAM (5 p.m. Saturday, June 3) is just $99.
This valuable resource of almost 400 individual presentations will be available shortly following the meeting’s conclusion, with access continued for up to one year.
The cost increases for VAM attendees after the meeting’s to $199, so buy now and save. For those who have already registered and now want to add the On-Demand Library, simply return to the registration page and add the library separately.
Don't forget you can take the Vascular Annual Meeting home with you! You can pre-purchase all VAM PowerPoint slides, audio and a limited selection of assorted videotaped sessions in the On-Demand Library. Purchase price through the conclusion of VAM (5 p.m. Saturday, June 3) is just $99.
This valuable resource of almost 400 individual presentations will be available shortly following the meeting’s conclusion, with access continued for up to one year.
The cost increases for VAM attendees after the meeting’s to $199, so buy now and save. For those who have already registered and now want to add the On-Demand Library, simply return to the registration page and add the library separately.
By Raysonho @ Open Grid Scheduler / Grid Engine (Own work)
