Active Surveillance Strategy Research Articles

Impact of cumulative burden of body mass index and waist circumference on risk of atrial fibrillation: an analysis of 3,700,000 participants who underwent 4-year consecutive annual health examination

Abstract Background There is limited evidence for the significance of the combination of waist circumference (WC), as a surrogate marker of central obesity, with body mass index (BMI) for predicting the risk of atrial fibrillation (AF). Furthermore, the additive value of the burden of BMI and WC cumulated over time on AF risk has not been reported. Purpose We sought to investigate the effect of cumulative burden of BMI, WC, and their combinations on the risk of AF using health check-up data from the Korean National Health Insurance Service. Methods This study included subjects aged >20 years who underwent four times of annual national health check-ups serially during 2009 to 2013, excluding those with a previous history of AF. The 4-year cumulative burden of BMI and WC was represented as burden-score calculated by the summation of BMI score (BMI 18.5–23 kg/m2, score 0; BMI 23–25 kg/m2, score 1; BMI ≥25 kg/m2, score 2) and WC score (WC <90 cm for men or <85 cm for women, score 0; WC ≥90 cm for men or ≥85 cm for women, score 1) at each year of health check-up. Newly developed AF was identified using claims data during a median follow-up of 5.2 years. AF risk was evaluated according to the burden of BMI, WC, and their combinations. A multivariate Cox regression model was used to adjust for baseline differences. Results Of 3,726,172 subjects (mean age 44.5±11.1, men 69.5%) enrolled, 27% had BMI burden-score of zero, while 23% had maximal burden-score of 8. For WC, 71% had zero burden-score and 7% had the highest burden-score of 4. Compared to the zero burden-score, maximal burden-score of BMI mildly increased the risk of AF, whereas the risk of AF predominantly increased in the group of maximal burden-score of WC. The different burdens of BMI in the same WC burden group did not significantly affect the risk of AF. Adjusted HR of each BMI burden-score (BMI burden zero as a reference) ranged from 1.01 to 1.12 in the group with WC burden-score zero, 0.84 to 1.06 in WC burden-score 1, 0.84 to 1.19 in WC burden-score 2, 0.59 to 0.83 in WC burden-score 3, and 0.62 to 1.55 in WC burden-score 4 without statistical significance. In contrast, high WC burden-score further increased the risk of AF even in groups with moderate to high burden of BMI (adjusted HR of maximal WC burden versus zero burden 1.97 [1.49–2.59] in the group with BMI burden-score 4; 1.66 [1.23–2.24] in BMI burden-score 5; 1.49 [1.16–1.91] in BMI burden-score 6; 1.43 [1.18–1.73] in BMI burden-score 7; and 1.49 [1.38–1.60] in BMI burden-score 8). Conclusions The 4-year cumulative burden of WC was a stronger determinant of future AF risk than BMI burden. Particularly in middle-ranged BMI burden groups that include persistently overweight but not obese population, high burden of WC substantially increased the risk of AF. The strategy of active surveillance for AF and comprehensive management of lifestyle and risk factors should focus on high-risk populations determined by the burden of WC. Funding Acknowledgement Type of funding sources: None.

Assessing the burden of dengue among household members in Alaminos, Laguna, the Philippines: a prospective cohort study.

The incidence of dengue is increasing rapidly and is a challenging health issue in the Philippines. Epidemiological data are largely based on a passive-surveillance reporting system, which leads to substantial under-reporting of cases. To estimate dengue infection and disease incidence prospectively at the community level in an endemic area of the Philippines using an active surveillance strategy. We implemented active surveillance in the highly endemic community of Alaminos, Laguna. The study consisted of a 1-year follow-up with 2 visits scheduled at the start and end of the study, as well as regular active surveillance in between and unscheduled visits for suspected cases. Blood samples were collected and analyzed to detect dengue during the first scheduled visit and all unscheduled visits, and clinical examination was performed at all visits (registered at clinicaltrials.gov NCT02766088). We enrolled 500 participants, aged from 6 months to 50 years; 76.2% were found positive for immunoglobulin G (95% confidence interval [CI], 71.9-80.0), with 92.0% among those aged 9-17 years. Active (weekly) surveillance identified 4 virologically confirmed cases of dengue (incidence proportion 0.8; 95% CI 0.3-2.1); all in participants aged ≤14 years. Routine surveillance programs such as sentinel sites are needed to characterize the entire clinical spectrum of symptomatic dengue, disease incidence, and transmission in the community.

Web-Based Ultrasonic Nomogram Predicts Preoperative Central Lymph Node Metastasis of cN0 Papillary Thyroid Microcarcinoma

BackgroundMany clinicians are facing the dilemma about whether they should apply the active surveillance (AS) strategy for managing Clinically Node-negative (cN0) PTMC patients in daily clinical practice. This research plans to construct a dynamic nomogram based on network, connected with ultrasound characteristics and clinical data, to predict the risk of central lymph node metastasis (CLNM) in cN0 PTMC patients before surgery.MethodsA retrospective analysis of 659 patients with cN0 PTMC who had underwent thyroid surgery and central compartment neck dissection. Patients were randomly (2:1) divided into the development cohort (439 patients) and validation cohort (220 patients). The group least absolute shrinkage and selection operator (Group Lasso) regression method was used to select the ultrasonic features for CLNM prediction in the development cohort. These features and clinical data were screened by the multivariable regression analysis, and the CLNM prediction model and web-based calculator were established. Receiver operating characteristic, calibration curve, Clinical impact curve and decision curve analysis (DCA) were used to weigh the performance of the prediction model in the validation set.ResultsMultivariable regression analysis showed that age, tumor size, multifocality, the number of contact surface, and real-time elastography were risk factors that could predict CLNM. The area under the curve of the prediction model in the development and validation sets were 0.78 and 0.77, respectively, with good discrimination and calibration. A web-based dynamic calculator was built. DCA proved that the prediction model had excellent net benefits and clinical practicability.ConclusionsThe web-based dynamic nomogram incorporating US and clinical features was able to forecast the risk of preoperative CLNM in cN0 PTMC patients, and has good predictive performance. As a new observational indicator, NCS can provide additional predictive information.

1523MO Initial active surveillance strategy for patients with peripheral sporadic desmoids: A multicentre phase II observational trial

Desmoid tumors (DT) are characterized by an unpredictable course. Most of the existing literature consists of retrospective studies. In a previous double-blind phase 3 trial comparing sorafenib and placebo, the 2-year Progression Free Survival (PFS) rate of the placebo group was 36% (Gounder NEJM 2018). However, assigned patients had already progressive or recurrent DT. The primary endpoint of this observational phase 2 study was to evaluate PFS and treatments at progression of newly diagnosed sporadic DT.

Preferences of Treatment Strategies among Women with Low-Risk DCIS and Oncologists.

Simple SummaryPreferences for treatment strategies for low-risk ductal carcinoma in situ (DCIS), a potential precursor of invasive breast cancer (IBC) including a new active surveillance strategy, were elicited with a discrete choice experiment among recently-diagnosed women and oncologists involved in the care of women with DCIS. Patients exhibited strong preferences for active surveillance and seemed prepared to accept much higher levels of 10-year risk of developing ipsilateral invasive breast cancer than oncologists. Both patients and oncologists showed a strong aversion toward more extensive locoregional treatments (i.e., breast conserving surgery followed by radiotherapy, and mastectomy), while both groups demonstrated a strong preference toward shorter follow-up intervals.As ongoing trials study the safety of an active surveillance strategy for low-risk ductal carcinoma in situ (DCIS), there is a need to explain why particular choices regarding treatment strategies are made by eligible women as well as their oncologists, what factors enter the decision process, and how much each factor affects their choice. To measure preferences for treatment and surveillance strategies, women with newly-diagnosed, primary low-risk DCIS enrolled in the Dutch CONTROL DCIS Registration and LORD trial, and oncologists participating in the Dutch Health Professionals Study were invited to complete a discrete choice experiment (DCE). The relative importance of treatment strategy-related attributes (locoregional intervention, 10-year risk of ipsilateral invasive breast cancer (iIBC), and follow-up interval) were discerned using conditional logit models. A total of n = 172 patients and n = 30 oncologists completed the DCE. Patient respondents had very strong preferences for an active surveillance strategy with no surgery, irrespective of the 10-year risk of iIBC. Extensiveness of the locoregional treatment was consistently shown to be an important factor for patients and oncologists in deciding upon treatment strategies. Risk of iIBC was least important to patients and most important to oncologists. There was a stronger inclination toward a twice-yearly follow-up for both groups compared to annual follow-up.

Trimodal Sono/Photoinduced Focal Therapy for Localized Prostate Cancer: Single‐Drug‐Based Nanosensitizer under Dual‐Activation

AbstractFocal therapy, or partial gland ablation, represents the middle ground between active surveillance and definitive treatment strategies against localized prostate cancer (PCa), among which the ultrasound‐ and light‐mediated focal therapies are quite promising. Herein, for the first time in the literature, a novel polysaccharide‐based nanoprodrug is fabricated for synergistic sonodynamic therapy and phototherapy against localized PCa. Specifically, the cyanine dye IR806 is conjugated to chondroitin sulfate (CS) via disulfide linkages to obtain CS‐ss‐IR806 (CSR) conjugates, which then self‐assemble to form CSR nanoparticles (NPs) with properties of enhanced endocytosis, redox/hyaluronidase‐responsiveness, and mitochondria‐targeted ability. In contrast to free sensitizers, CSR NPs reveal dramatically enhanced water solubility, substantially lower dark toxicity, and superior biocompatibility. Encouragingly, favorable hyperthermia and high reactive oxygen species generation are observed on exposing CSR NPs to combined sono/photoirradiation. In a PCa tumor‐bearing mice model, intratumoral injection with a markedly low dose of CSR NPs followed by dual‐irradiation results in superior trimodal anticancer efficacy when compared with either monoirradiation strategy. Such synergistic antitumor efficacy is further demonstrated to be associated with the common and complementary mechanisms of sonotherapy and phototherapy. This work provides a promising approach as a next‐generation focal therapy strategy against localized PCa.

Indication for Active Surveillance in the Era of MRI-Targeted Prostate Biopsies

Introduction: Active surveillance (AS) strategies were established to avoid overtreatment of low-risk prostate cancer (PCa) patients. Low tumor volume represents one indication criteria; however, applying this criterion after MRI-targeted prostate biopsies may lead to overestimation of tumor volume; wherefore, patients suitable for AS would be exposed to the risk of overtreatment. Methods: This retrospective analysis included 318 patients in which PCa was detected by MRI-TRUS fusion prostate biopsy. Classic and extended indication for AS included Gleason 6 and Gleason 3 + 4 cancer, respectively. We assessed the effect of targeted biopsies and temporary rating strategies on eligibility for AS and developed new “composite” algorithms to more accurately assess eligibility for AS. Results: Forty-four (13.8%) and 60 (18.9%) of the 318 patients qualified for AS according to “classic” and “extended” criteria, respectively. Application of the “composite 1” definition led to AS eligibility of 52 of 248 patients (20.97%) in the classic and of 77 of 248 patients (31.05%) in the “extended” group. Conclusions: We could demonstrate that classic algorithms led to ineligibility of patients for AS. We propose a new rating algorithm to improve tumor assessment for a more accurate indication for AS.

Active Surveillance Strategies for Low-Grade Prostate Cancer: Comparative Benefits and Cost-effectiveness.

Background Active surveillance (AS) is the recommended treatment option for low-risk prostate cancer (PC). Surveillance varies in MRI, frequency of follow-up, and the Prostate Imaging Reporting and Data System (PI-RADS) score that would repeat biopsy. Purpose To compare the effectiveness and cost-effectiveness of AS strategies for low-risk PC with versus without MRI. Materials and Methods This study developed a mathematical model to evaluate the cost-effectiveness of surveillance strategies in a simulation of men with a diagnosis of low-risk PC. The following strategies were compared: watchful waiting, prostate-specific antigen (PSA) and annual biopsy without MRI, and PSA testing and MRI with varied PI-RADS thresholds for biopsy. MRI strategies differed regarding scheduling and use of PI-RADS score of at least 3, or a PI-RADS score of at least 4 to indicate the need for biopsy. Life-years, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios were calculated by using microsimulation. Sensitivity analysis was used to assess the impact of varying parameter values on results. Results For the base case of 60-year-old men, all strategies incorporating prostate MRI extended QALYs and life-years compared with watchful waiting and non-MRI strategies. Annual MRI strategies yielded 16.19 QALYs, annual biopsy with no MRI yielded 16.14 QALYs, and watchful waiting yielded 15.94 QALYs. Annual MRI with PI-RADS score of at least 3 or of at least 4 as the biopsy threshold and annual MRI with biopsy even after MRI with negative findings offered similar QALYs and the same unadjusted life expectancy: 23.05 life-years. However, a PI-RADS score of at least 4 yielded 42% fewer lifetime biopsies. With a cost-effectiveness threshold of $100 000 per QALY, annual MRI with biopsy for lesions with PI-RADS scores of 4 or greater was most cost-effective (incremental cost-effectiveness ratio, $67 221 per QALY). Age, treatment type, risk of initial grade misclassification, and quality-of-life impact of procedural complications affected results. Conclusion The use of active surveillance (AS) with biopsy decisions guided by findings from annual MRI reduces the number of biopsies while preserving life expectancy and quality of life. Biopsy in lesions with PI-RADS scores of 4 or greater is likely the most cost-effective AS strategy for men with low-risk prostate cancer who are younger than 70 years. © RSNA, 2021 Online supplemental material is available for this article. An earlier incorrect version appeared online. This article was corrected on July 13, 2021.

P1041 - An MRI guided active surveillance strategy. Can the PRECISE score exclude reclassification?

P1041 - An MRI guided active surveillance strategy. Can the PRECISE score exclude reclassification?

Pool Strategy for Surveillance Testing of SARS-CoV-2

Due to the great morbidity and mortality in the risk groups of the pandemic COVID-19 caused by the emerging coronavirus SARS-CoV-2 and in the absence of effective therapeutic or preventive measures, quarantines, social distancing and the use of masks were the measures most used by health systems to reduce infections. The social, economic and health impact caused by these measures have begun to be evaluated in the different countries. These analyses lead to underestimations because in general they evaluate disease confirmed by a laboratory test and in some cases by epidemiological link without considering asymptomatic or oligosymptomatic infection. Therefore, mitigating fast circulation of the virus requires continuous tracking, detection, and isolation of cases, for which active surveillance able to address asymptomatic cases can make a valuable contribution over the dynamics of the disease in a given society, and to allocate adequate health resources and evaluate the effectiveness of control measures. Mathematical models such as the Susceptible-Exposed-Infectious-Removed (SEIR) allow not only to improve the estimates of the evolution of the pandemic at the local level, but also to evaluate health strategies. In the context of large testing requirements and the expansion of such testing capacity, it is also essential to develop approaches that improve the efficient use of these resources. Active surveillance undoubtedly contributes to improving estimates of virus circulation and it is of particular importance in vulnerable groups of high population density that have one or more risk factors, difficult access to the health system, and inhabit semi-closed facilities such as residential care homes, mental hospitals, prison houses, police stations housing prisoners, etc. Group testing strategies are especially useful for routine community survey and for monitoring of cohesive groups. While the frequency of infection in a population, who have only some symptoms compatible with the disease or do not have any symptoms, may be low, diagnosing even a single positive person typically requires quarantine of the entire group to prevent further spread in the community. In these surveillance strategies, pooling may allow more routine monitoring and detection of low frequency of carriage, thereby improving estimates, informing policy makers, reducing transmission, and alleviating the strain on healthcare services. By means of molecular tests based on RT-qPCR, the pooling strategy has been assayed with different algorithms also for COVID-19, particularly in the asymptomatic population, since a low prevalence of the disease is expected there. This has increased SARS-CoV-2 testing throughput while maintaining high sensitivity. Here, we discuss the relevance of some active surveillance strategies to determine key facts about COVID-19 pandemics and review different testing strategies that different countries have applied for tracking SARS-CoV-2.

Top van de ijsberg: indrukwekkende intrathoracale goiter

Tip of the iceberg: massive intrathoracic goiter In this article a case of an 80 year-old man with an impressive intrathoracic goiter is described. Thorough evaluation of the structural and functional impact and the risk of malignancy is needed. Theoretically, the management can consist of surgical resection, radioactive iodine, anti-thyroid drugs (in case of hyperthyroidism), or active surveillance. Multidisciplinary consultation is essential in cases of goiter with an important intrathoracic component. Based on the absence of compressive problems, the mild hyperthyroidism, the low risk of thyroid cancer and the anticipated slow growth, an active surveillance strategy was chosen.

Overexpression of the TRIM24 E3 Ubiquitin Ligase is Linked to Genetic Instability and Predicts Unfavorable Prognosis in Prostate Cancer.

Tripartite motif containing 24 (TRIM24) is a multifunctional protein involved in p53 degradation, chromatin binding, and transcriptional modulation of nuclear receptors. Emerging research has revealed that upregulation of TRIM24 in numerous tumor types is linked to poor prognosis, attributing an important role to TRIM24 in tumor biology. In order to better understand the role of TRIM24 in prostate cancer, we analyzed its immunohistochemical expression on a tissue microarray containing >17,000 prostate cancer specimens. TRIM24 immunostaining was detectable in 61% of 15,321 interpretable cancers, including low expression in 46% and high expression in 15% of cases. TRIM24 upregulation was associated with high Gleason grade, advanced pathologic tumor stage, lymph node metastasis, higher preoperative prostate-specific antigen level, increased cell proliferation as well as increased genomic instability, and predicted prognosis independent of clinicopathologic parameters available at the time of the initial biopsy (all P<0.0001). TRIM24 upregulation provides additional prognostic information in prostate cancer, particularly in patients with low Gleason grade tumors who may be eligible for active surveillance strategies, suggesting promising potential for TRIM24 in the routine diagnostic work-up of these patients.

Feasibility of active surveillance in small testicular mass: a mini review

IntroductionWidespread use of scrotal ultrasonography has led to the detection of incidental, non-palpable small testicular masses (STMs). Historically, all intratesticular masses were treated radically, however more conservative strategies are now being applied with growing evidence that up to 80% of STMs are benign lesions. Testis-sparing surgery is deemed a gold standard in STMs. However, the high probability of the benign nature of STMs and the excellent cure rate of localized testicular cancer has led to emerging attempts to use an active surveillance (AS) strategy for selected groups of patients.Material and methodsWe conducted a non-systematic review of the literature in the PubMed and Embase databases for articles associated with AS strategy in STMs.ResultsThe main inclusion criteria for AS in patients with STMs were lack of risk factors of testicular cancer, no features of disseminated disease, negative tumor markers, non-palpable lesion that did not exceed 10 mm. Mean follow-up time of AS across the studies ranged from 9.6 to 29.6 months. Surveillance protocols were based on regular physical examination, scrotal ultrasonography and measurement of tumor markers. The change rate to active treatment ranged from 0% to 8% without reported deterioration of oncological outcomes. Patients have proceeded to surgical treatment based on their preference, lesion growth, change in echogenicity, tumor marker growth and the need for testicular exploration for other reasons.ConclusionsActive surveillance is a reasonable conservative strategy in the management of STMs in selected groups of patients with minimal risk of deteriorating impact on oncological outcomes.

122 Poster - Non-intervention vs. surgical interventions in (Low-Risk) Ductal Carcinoma In Situ: A DCIS multi-state model for decision analytics

Background: An active surveillance strategy has been proposed for patients with low- and intermediate-grade ductal carcinoma in situ (DCIS). Prospective trials to measure clinical outcomes are on-going, and results will not be available for >10 years. In lieu of prospective data, there is value in creating a disease model for low-risk DCIS to understand the potential impact of an active surveillance strategy.

257 CHEMORADIOTHERAPY FOLLOWED BY ACTIVE SURVEILLANCE VERSUS SURGERY FOR ESOPHAGEAL CANCER: A SYSTEMATIC REVIEW AND INDIVIDUAL PATIENT DATA META-ANALYSIS

Abstract Up to 50% of patients with esophageal cancer have a pathologically complete response after neoadjuvant chemoradiotherapy (nCRT) plus surgery. An active surveillance strategy may be feasible in patients with a complete clinical response (cCR) after nCRT. The aim of this study was to perform a meta-analysis using data of individual patients that underwent active surveillance with surgery for recurrent disease versus standard surgery after nCRT. Methods A systematic search was performed in Embase, Medline, Web of Science, Scopus and Cochrane from inception to February 2020. Studies were sought that reported on overall survival and recurrence rates in patients with cCR after nCRT that underwent active surveillance versus standard surgery. Authors were contacted to supply individual patient data. Pooled hazard ratio (HR) comparing survival outcomes and distant dissemination rates (DDR) between patients with cCR undergoing active surveillance or standard surgery were estimated using a random-effect meta-analysis. Cumulative incidence of locoregional recurrences in active surveillance were assessed using a Cox Frailty model. Results Seven studies including 788 patients (256 active surveillance and 532 surgery) were identified. All authors provided anonymized patient data. Pooled two- and five-year overall-survival was 75% and 58% for active surveillance and 76% and 60% for standard surgery with a pooled HR of 1.04 (95%CI:0.73–1.49) (Figure 1). Two-years DDR was 18% and 19% for active surveillance and standard surgery, respectively (HR 1.10,95%CI:0.75–1.63). Locoregional recurrence rate necessitating esophagectomy in patients undergoing active surveillance was 24% at one year, 33% at two years and 38% at five years. Active surveillance patients undergoing postponed surgery had R0 in 91% of cases. Conclusion Overall survival is comparable in patients undergoing active surveillance with postponed surgery compared to standard surgery after neoadjuvant chemoradiation. Distant dissemination rate is also comparable between both groups. During active surveillance, local regrowths developing after two years are rare. Although these data support an active surveillance strategy, randomized trials have to be completed before an active surveillance strategy can be actively proposed to patients with esophageal cancer.

Cost-Effectiveness of Initial Versus Delayed Lanreotide for Treatment of Metastatic Enteropancreatic Neuroendocrine Tumors.

The Controlled Study of Lanreotide Antiproliferative Response in Neuroendocrine Tumors (CLARINET) trial showed prolonged progression-free survival in patients initially treated with lanreotide versus placebo. We evaluated the cost-effectiveness of upfront lanreotide versus active surveillance with lanreotide administered after progression in patients with metastatic enteropancreatic neuroendocrine tumors (NETs), both of which are treatment options recommended in NCCN Clinical Practice Guidelines in Oncology for Neuroendocrine and Adrenal Tumors. We developed a Markov model calibrated to the CLARINET trial and its extension. We based the active surveillance strategy on the CLARINET placebo arm. We calculated incremental cost-effectiveness ratios (ICERs) in dollars per quality-adjusted life-year (QALY). We modeled lanreotide's cost at $7,638 per 120 mg (average sales price plus 6%), used published utilities (stable disease, 0.77; progressed disease, 0.61), adopted a healthcare sector perspective and lifetime time horizon, and discounted costs and benefits at 3% annually. We examined sensitivity to survival extrapolation and modeled octreotide long-acting release (LAR) ($6,183 per 30 mg). We conducted one-way, multiway, and probabilistic sensitivity analyses. Upfront lanreotide led to 5.21 QALYs and a cost of $804,600. Active surveillance followed by lanreotide after progression led to 4.84 QALYs and a cost of $590,200, giving an ICER of $578,500/QALY gained. Reducing lanreotide's price by 95% (to $370) or 85% (to $1,128) per 120 mg would allow upfront lanreotide to reach ICERs of $100,000/QALY or $150,000/QALY. Across a range of survival curve extrapolation scenarios, pricing lanreotide at $370 to $4,000 or $1,130 to $5,600 per 120 mg would reach ICERs of $100,000/QALY or $150,000/QALY, respectively. Our findings were robust to extensive sensitivity analyses. The ICER modeling octreotide LAR is $482,700/QALY gained. At its current price, lanreotide is not cost-effective as initial therapy for patients with metastatic enteropancreatic NETs and should be reserved for postprogression treatment. To be cost-effective as initial therapy, the price of lanreotide would need to be lowered by 48% to 95% or 27% to 86% to reach ICERs of $100,000/QALY or $150,00/QALY, respectively.

The role of an active surveillance strategy of targeting household and neighborhood contacts related to leprosy cases released from treatment in a low-endemic area of China.

ObjectiveEarly diagnosis remains the primary goal for leprosy management programs. This study aims to determine whether active surveillance of patients with leprosy and their contact individuals increased identification of latent leprosy cases in the low-endemic areas.MethodsThis cross-sectional survey was carried out between October 2014 and August 2016 in 21 counties throughout Shandong Province. The survey was conducted among patients with leprosy released from treatment (RFT) and their contacts from both household and neighbors.ResultsA total of 2,210 RFT patients and 9,742 contacts comprising 7877 household contacts (HHCs), including 5,844 genetic related family members (GRFMs) and 2033 non-genetic related family members and 1,865 contacts living in neighboring houses (neighbor contacts, NCs), were recruited. Among identified individuals, one relapsed and 13 were newly diagnosed, giving a detection rate of 0.12%, corresponding to 120 times the passive case detection rate. Detection rates were similar for HHCs and NCs (0.114% vs. 0.214%, P = 0.287). Analysis of the family history of leprosy patients revealed clustering of newly diagnosed cases and association with residential coordinates of previously-diagnosed multibacillary leprosy cases.ConclusionActive case-finding programs are feasible and contributes to early case detection by tracking HHCs and NCs in low-endemic areas.

Radical nephrectomy and partial nephrectomy

Renal cell carcinoma is the 2nd most frequent urological malignancy in women and the third most frequent in men, with an age peak in the seventh decade of life. If detected early in a local non-metastatic stage, options for complete recovery are excellent. While two decades ago, even locally limited cancers of the kidney were cured by radical nephrectomy, treatment today mostly consists of local treatment for locally confined cancers. Guidelines today recommend local surgical excision (open or minimally-invasive) or - in selected cases - topical energy application (radio-frequency ablation, cryoablation). The surgeon's expertise is most important in the selection of the appropriate kind of surgery and different guidelines have slightly different recommendations.Treatment decisions should be made on an individual basis in due consideration of an individual's age and co-morbidities. This may lead to the recommendation that, due to low perioperative morbidity, even localised carcinomas should be treated by (minimally-invasive) radical nephrectomy instead of nephron-sparing surgery and, in other cases, a non-interventional, active surveillance strategy may be pursued without compromising the patient's life expectancy. For higher-grade renal cell carcinomas, there is usually an indication for radical nephrectomy, as long as no metastases are detected. This also applies to carcinomas with venous thrombi extending into the atrium of the heart. Complications in the treatment of renal carcinomas are usually rare and easily treatable in most cases.

Test, Treat, Track, Test, and Treat Active Surveillance toward Elimination of Schistosomiasis: A Feasibility Study.

.We assessed the feasibility of using a test, treat, track, test, and treat (5T) active surveillance strategy to identify and treat individuals with schistosomiasis in three very low-prevalence villages in Kafr El Sheikh Governorate, Egypt. Primary index cases (PICs) were identified using the point-of-care circulating cathodic antigen (POC-CCA) assay in schools, in rural health units (retesting individuals with positive Kato–Katz examinations over the previous 6 months), and at potential water transmission sites identified by PICs and field observations. Primary cases identified potential second-generation cases—people with whom they shared water activities—who were then tracked, tested, and treated if infected. Those sharing water activities with second-generation cases were also tested. The yield of PICs from the three venues were 128 of 3,576 schoolchildren (3.6%), 42 of 696 in rural health units (6.0%), and 83 of 1,156 at water contact sites (7.2%). There were 118 second- and 19 third-generation cases identified. Persons testing positive were treated with praziquantel. Of 388 persons treated, 368 (94.8%) had posttreatment POC-CCA tests 3–4 weeks after treatment, and 81.8% (301) became negative. The 67 persons remaining positive had negative results after a second treatment. Therefore, all those found positive, treated, and followed up were negative following one or two treatments. Analysis of efforts as expressed in person-hours indicates that 4,459 person-hours were required for these 5T activities, with nearly 65% of that time spent carrying out interviews, treatments, and evaluations following treatment. The 5T strategy appears feasible and acceptable as programs move toward elimination.

Information-theoretic sensor planning for large-scale production surveillance via deep reinforcement learning

Production surveillance is the task of monitoring oil and gas production from every well in a hydrocarbon field. Accurate surveillance is a basic necessity for several reasons that include improved resource management, better equipment health monitoring, reduced operational cost, and ultimately optimal hydrocarbon production. A key challenge in this task, especially for large fields with many wells, is the measurement of multiphase fluid flow using a limited number of noisy sensors of varying characteristics. Current surveillance practices are based on fixed utilization schedules of such flow sensors, which rarely change over time. Such a passive mode of sensing is completely agnostic to surveillance performance and thus often fails to achieve a desired accuracy. Here we propose an active surveillance approach, underpinned by the concept of value of information-based sensing. Borrowing some well-known concepts from Markov decision processes, reinforcement learning and artificial neural networks, we demonstrate that a practical active surveillance strategy can be devised, which can not only improve surveillance performance significantly, but also reduce usage of flow sensors.