Oncologic and Functional Outcomes of Active Surveillance and Ablative Therapy for Small Renal Masses: A Systematic Review and Meta-Analysis.

Who, When, and How: Watchful Waiting in the ERSPC Rotterdam.

Renal oncocytic neoplasms present diagnostic challenges, both at imaging and pathologic evaluation. The World Health Organization classification of renal neoplasms defines a spectrum of oncocytic neoplasms, including emerging entities that help define previously uncharacterized or mischaracterized tumors. Low-grade oncocytic tumors and eosinophilic vacuolated tumors are distinguishable from other oncocytic neoplasms at pathologic evaluation and typically demonstrate indolent behavior. Nomenclature regarding hybrid neoplasms has been clarified in reference to hereditary cases associated with Birt-Hogg-Dubé syndrome. Preoperative diagnostic difficulties at imaging contribute to high rates of resected benign renal tumors, the majority being renal oncocytomas. The imaging appearances of oncocytic neoplasms are similar, and the inability to confidently diagnose them at imaging has led to increased resection rates. Preoperative renal mass biopsy may be preventative, but its utilization remains low, diagnoses can be equivocal, and establishing tumor aggressiveness may not always be reliable. Malignant renal oncocytic tumors, including chromophobe renal cell carcinoma, are generally considered the less aggressive subtypes of renal cell carcinoma. However, distinguishing them from the more aggressive clear cell subtype remains challenging, despite imaging frameworks designed to aid categorization. Active surveillance is a safe management option among biopsy-confirmed renal oncocytic neoplasms, but it remains uncertain which patients are suitable for this approach. Diagnostic imaging may assist in risk-stratifying oncocytic neoplasms, with mass enhancement, heterogeneity, and calcification potentially differentiating benign from malignant oncocytic neoplasms. Mass attenuation and heterogeneity may differentiate low-grade and high-grade cancers. Molecular imaging and other emerging techniques, such as MR fingerprinting, may play a role in the future. ©RSNA, 2026 Supplemental material is available for this article.

Bladder preservation strategies for muscle-invasive bladder cancer (MIBC) are gaining renewed interest as advances in systemic therapy, imaging, and molecular biomarkers challenge the historical primacy of radical cystectomy. This review is timely given increasing rates of clinical and pathological complete response with contemporary neoadjuvant regimens and the growing exploration of response-adapted approaches, including active surveillance. Trimodal therapy has been an established bladder-preserving option for carefully selected patients, with long-term oncologic outcomes comparable to radical cystectomy in selected cohorts, though randomized comparisons are lacking. Intensified neoadjuvant strategies incorporating immunotherapy and antibody-drug conjugates have substantially improved oncological outcome and pathological complete response rates, expanding the population potentially eligible for bladder preservation. Concurrently, advances in multiparametric MRI, molecular subtyping, and liquid biopsy technologies have improved response assessment and risk stratification, although lack of standardization and prospective validation limits routine implementation. Early-phase trials suggest that active surveillance after clinical complete response may be feasible in highly selected patients, but long-term safety remains uncertain. Bladder preservation in MIBC is evolving toward a response-adapted paradigm that integrates novel systemic therapy, multimodal restaging, and patient-centred outcomes.

Sterotactic ablative radiotherapy vs. thermal ablation of localized renal cell carcinoma: Is there a preferred second-line management option?

Finding Holes: Pathologist-Level Performance Using AI for Cribriform Morphology Detection in Prostate Cancer.

Effectiveness of monovalent rotavirus vaccine among young children in Pakistan: a test-negative case-control evaluation.

High-grade acinar prostatic adenocarcinoma, characterized by a Gleason score exceeding 7 (Grade Groups 4 or 5), is associated with a poorer prognosis, including increased risks of recurrence and metastasis. While much research has focused on high-grade prostate cancer diagnosed via needle biopsy, little is known about the clinical implications of incidental high-grade prostate cancer found in transurethral resection of the prostate (TURP) specimens. This study reviews the clinical outcomes of 18 patients with high-grade prostate cancer involving ≤ 5% of TURP tissue, diagnosed between 2014 and 2024. Inclusion criteria included a first-time diagnosis of prostate cancer, acinar adenocarcinoma with a Gleason score of 8 or higher, and involvement of less than 5% of TURP tissue. Clinical data, including age, prostate-specific antigen levels, treatment type, and follow-up, were recorded. The cohort had a mean age of 75 years, and the follow-up period averaged 34 months. Histopathologic findings included Grade Groups 4 and 5 tumors, with intraductal prostatic carcinoma (IDC) found in 5 patients. Treatment varied, with 39% receiving hormonal therapy and radiotherapy, 33% opting for active surveillance, and 11% undergoing radical prostatectomy. Notably, 17% of patients experienced disease progression, with IDC present in all of these patients. Despite low-volume disease (≤ 5% of specimens), a notable proportion of patients developed metastasis or died from prostate cancer, challenging the traditional view that incidental findings in TURP are of limited consequence. Patients with IDC appear especially vulnerable to adverse outcomes.

Development of Mycobacterium tuberculosis post in vitro fertilization and embryo transfer: A case series derived from a multi-omics analysis and literature review.

Acute pyelonephritis in the emergency department: Comparing clinical and prognostic outcomes for community and long-term care.

Candida auris is an emerging multidrug-resistant yeast associated with invasive infections, healthcare-associated outbreaks, and high mortality, and is often misidentified by conventional diagnostic methods. Rapid, accurate, and scalable screening tools are essential for effective infection control, particularly in high-risk settings. We developed a multiplex loop-mediated isothermal amplification (LAMP) assay that combines a broad-range Candida Pan target with a C. auris-specific target in a single isothermal reaction. Assay conditions were optimized for primer ratio and temperature, and analytical sensitivity was evaluated using serial dilutions of culture-derived C. albicans and C. auris DNA, as well as contrived specimens consisting of urine, swab, and whole-blood matrices. Clinical performance was assessed using 35 Candida-positive clinical specimens (blood, urine, ear swabs) and 94 non-infectious controls. Results were compared with Candida Pan qPCR and C. auris qPCR. Cross-reactivity was tested against common bacterial isolates. Under optimized conditions (1:1 primer ratio, 64 °C), the assay allowed species-level discrimination, with C. auris positive for both Pan and auris channels and C. albicans positive only for the Pan channel. The C. auris-specific LAMP probe detected approximately 10²-10³ cells/mL in culture-derived and contrived specimens, showing a 1-2 log improvement over C. auris qPCR (10⁴-10⁵ cells/mL), while the Pan LAMP channel detected C. auris at around 10⁵ cells/mL. In clinical specimens, Pan LAMP detected Candida spp. in 34/35 cases (97.14%) versus 32/35 (91.14%) for Pan qPCR. All C. auris-positive specimens (9/9) were detected by the multiplex LAMP assay, compared with 6/9 (66.7%) by Pan qPCR. All 94 non-infectious controls and all bacterial isolates tested negative, indicating 100% clinical specificity and absence of cross-reactivity. The multiplex Candida Pan/auris LAMP assay provides a rapid, highly sensitive, and specific alternative to qPCR for C. auris screening, while preserving broad Candida detection in a single isothermal reaction. Its improved analytical and clinical sensitivity suggests strong potential for use in active surveillance and infection-control programs, particularly in settings where timely identification and containment of C. auris are critical.

Background and study aims The need for routine EUS-FNB of small (≤20mm) non-functioning pancreatic neuroendocrine tumors (NF-PanNETs) remains debated. We aimed to evaluate the impact of EUS-FNB on clinical management in patients with very small (≤10mm) and small (11-20mm) suspected NF-PanNETs who were otherwise suitable for active surveillance. Patients and methods Retrospective analysis of patients with single, sporadic, ≤20mm lesions, exhibiting typical imaging features of NF-PanNET, referred for EUS-FNB at two high-volume centers between January 2017 and December 2024. The primary outcome was the impact of EUS-FNB on management, defined as a diagnosis leading to a strategy other than active surveillance. Secondary outcomes included factors associated with a substantial management change, sample adequacy, safety, Ki-67 assessment, and concordance between EUS-FNB and surgical grading. Results Overall, 417 patients (160 with very small and 257 with small lesions) were included. EUS-FNB changed management in 68 cases (16.3%), more frequently in small than in very small lesions (19.8% vs. 10.6%; P=0.014). A substantial impact leading to surgical resection was more frequent in small lesions (12.4% vs. 3.7%; P=0.002). Lesion size 11-20mm was independently associated with a substantial impact (OR 3.19, 95%CI 1.05-9.66). Sample adequacy was 96.1%, adverse events rate was 3.4%, Ki-67 was feasible in 96.0% of confirmed PanNETs, and grading concordance with surgical specimens was 78.1%. Conclusions In patients with suspected small NF-PanNETs without suspicious features, EUS-FNB provides a clear clinical benefit for larger lesions. For very small (≤10mm) lesions, its more limited impact supports an individualized, shared decision-making with the patient.

ABSTRACT Background Autochthonous dengue transmission is increasingly being reported in temperate regions of Europe, particularly in areas with established Aedes albopictus populations and high population mobility. We describe a locally acquired dengue outbreak identified in Vila-seca (Tarragona, north-eastern Spain), which involved eight confirmed cases, two of which were asymptomatic, and the associated public health response. Methods Following the notification of two non-travel–associated dengue cases in September 2024 at Hospital Universitari de Tarragona Joan XXIII, epidemiological, virological, and entomological investigations were conducted led by Public Health Agency of Catalonia with the collaboration of microbiology departments of Vall d’Hebron Hospital Universitari and Hospital Clínic of Barcelona. Active case finding, contact tracing, laboratory confirmation, viral sequencing, and vector surveillance were implemented in the affected area of Vila-seca (Spain). Results A total of eight confirmed dengue cases were identified. The index cases were two residents without travel history who presented with fever, rash, and myalgia and tested positive for dengue virus (DENV). Four additional cases were detected through active surveillance, including three household contacts employed at a nearby entertainment resort and one resident living approximately 160 meters from the index household. Two further epidemiologically linked cases were identified among French tourists following international alerts. All patients recovered, and no additional cases were detected after November 2024, coinciding with decreased vector activity. Virological analysis confirmed local transmission of DENV-1, genotype V (clade D.2). Entomological surveys demonstrated widespread Ae. albopictus presence in public and private settings, prompting immediate vector control interventions, although no infected mosquitoes were detected. Conclusions This outbreak illustrates the growing risk of DENV transmission in non-endemic European settings with intense tourist and occupational mobility. Rapid diagnostics, genomic surveillance, coordinated vector control, and timely international communication are essential to limit transmission and protect both residents and travellers, reinforcing the importance of a One Health approach.

Using CDC's Active Bacterial Core surveillance data, we observed increasing incidence of rare group B Streptococcus serotypes VI and VIII, from 0.007 and 0 cases per 100,000 in 2007 to 0.14 and 0.13 in 2023, respectively. These serotypes disproportionally impacted American Indian/Alaska Native, Asian, and Native Hawaiian/Pacific Islander populations.

The global rise of carbapenem-resistant Pseudomonas aeruginosa (CRPA) poses a significant threat to public health. Through active surveillance conducted between 2021 and 2022, we collected 92 distinct CRPA isolates and identified a clonal shift toward high-risk lineages ST235* and ST292. Whole-genome sequencing and phylogenomic analysis revealed that ST235*, a single-locus variant of epidemic ST235, exhibited broader antimicrobial resistance (AMR) and carried a nalD loss-of-function mutation, resulting in MexAB-OprM overexpression. Two ST235* isolates contained a hybrid resistance cassette with bla KPC-2 and bla TEM-1, likely acquired through IS26-mediated transfer from Enterobacter hormaechei. Most ST292 isolates demonstrated an extensively drug-resistant phenotype with a bla CARB-2-containing cassette and a chromosomally integrated tMexC3D-OprJ efflux system. Additionally, ST244 isolates possessed a bla VIM-2 cassette embedded within a Tn402 transposition module (tniABQR-intI1). Multiple copies of tniABQR-intI1 carrying AMR genes were exclusively found in the genomes of ST244, representing a novel mechanism. The genomic plasticity of high-risk CRPA lineages emphasizes their capacity to acquire, amplify and disseminate AMR determinants. To combat the spread of CRPA, genomic surveillance and targeted infection control strategies are urgently required.

Introduction Diagnosing autoimmune arthritis in patients with advanced osteoarthritis can be challenging, especially in the early stages of the disease. Overlapping symptoms often lead to delayed diagnosis and ineffective treatment focused solely on degenerative or mechanical changes. Case description We present the case of a 66-year-old female with a long-standing history of advanced osteoarthritis of the hands (Heberden’s and Bouchard’s nodes). The patient reported pain in the right heel (radiating to the Achilles tendon) for approximately 3 months and pain in the second left toe for 2 weeks. Laboratory tests, including rheumatoid factor (RF), antibodies to cyclic citrullinated peptide, and HLA-B27, were negative. A family history revealed psoriasis in the patient’s mother. Initially, the patient received orthopaedic treatment based on an ultrasound diagnosis of Achilles tendinopathy. Despite receiving a platelet-rich plasma injection and subsequent non-steroidal anti-inflammatory drugs therapy, no significant clinical improvement was observed. During a rheumatological consultation, an ultrasound was performed. The examination revealed clear signs of enthesitis of the right Achilles tendon (increased Power Doppler signal and thickening) and inflammation of the MTP-2 flexor pulley, accompanied by subcutaneous tissue inflammation consistent with dactylitis. Based on the CASPAR criteria (3 points: negative RF, family history of psoriasis, and dactylitis), psoriatic arthritis was diag nosed. Treatment with methotrexate (20 mg/week) and prednisone (10 mg/day) was initiated, and the patient remains under regular rheumatological follow-up to monitor treatment efficacy. Conclusions This case illustrates that autoimmune arthritis can pose significant diagnostic difficulties in patients with pre-existing musculoskeletal disorders. It highlights the necessity for clinical vigilance whenever new joint pain patterns emerge. Rheumatologist-performed ultrasound at the point of care remains a crucial diagnostic tool for differentiating inflammatory from mechanical pathologies.

Intermittent preventive treatment in pregnancy (IPTp) with dihydroartemisinin-piperaquine (IPTp-DP) is more effective than sulfadoxine-pyrimethamine (IPTp-SP) at reducing the burden of malaria in pregnancy in settings with high SP resistance. Paradoxically, IPTp-DP has been associated with lower birth weights compared with IPTp-SP. Whether the impacts of IPTp-DP extend after birth is unknown. We conducted a double-blind randomized controlled trial to compare malaria burden and growth among infants born to mothers who were randomized to monthly IPTp-SP, IPTp-DP, or IPTp-DP+SP. Infants were followed to 12 months of age by passive and active surveillance. The primary outcome was clinical malaria incidence; secondary outcomes included parasite prevalence by microscopy or quantitative PCR, and infant growth outcomes. Among 871 infants enrolled, there were 667 episodes of clinical malaria. Compared to infants whose mothers received IPTp-SP, malaria incidence was similar in infants whose mothers received IPTp-DP (incidence rate ratio [IRR] 1.04, 95% confidence interval (CI) 0.78-1.38) or IPTp-DP+SP (IRR=0.93, 95% CI 0.68-1.26). Overall parasite prevalence at monthly visits was 21.8%. Parasite prevalence was also similar between groups. The prevalence of wasting at birth was higher in infants whose mothers received IPTp-DP+SP (PR= 2.30, 95% CI 1.07, 4.97) or IPTp-DP (RR= 2.25, 95% CI 1.03, 4.94) than those that received IPTp-SP, but differences between groups resolved by 3-6 months of age. There were no significant differences in infant outcomes between the three IPTp arms apart from a transiently increased risk of wasting among infants born to mothers who received DP-containing IPTp regimens.

The continued global spread of WOAH-listed pathogens via trade, transport, and travel calls for the implementation of biosecurity measures to protect the health of our national livestock industries, plus ongoing surveillance to verify that such measures are operative. Despite this urgency, surveillance must be practical and affordable. Herein, we evaluated the performance and cost of participatory surveillance, a nontraditional surveillance design, using the U.S. swine industry as an example. In this context, "participatory" meant that herd veterinarians and/or producers collected and submitted samples from the herd to accredited laboratories for testing. To create an infected population (Phase 1), we simulated the introduction and spread of an unspecified notifiable pathogen within the 48 contiguous U.S states (66,637 swine farms, within 8,080,470 km2) using the USDA Animal Disease Spread Model software (v3.5.10.0). In Phase 2, we calculated the probability of detecting ≥1 infected farm as a function of producer participation, farm-level sensitivity, farm-level prevalence, and sampling frequency. The participatory design was effective: ≥90% probability of detecting the notifiable pathogen at 0.05% farm prevalence (33 positive farms among 66,637 farms) when farm-level sensitivity was ≥20% and producer participation was ≥40%. Depending on the specimen collected, the shipment method, and the test selected, costs ranged from $0.03 to $0.07 USD (€0.02 to €0.06) per pig in inventory. Thus, a surveillance design based on collecting and testing specimens from a few targeted pigs on each of many farms would be both affordable and effective at a national level.

The collared peccary (Pecari tajacu) is a member of the Tayassuidae family widely distributed throughout the Americas, particularly in Brazil. These animals have important ecologic functions and, despite their good conservation status, are frequently affected by anthropogenic pressures. Candida spp. are commensal yeasts present in the microbiota of various hosts; however, under conditions that disrupt microbial balance, they can become opportunistic pathogens. Some Candida spp. are also of great relevance to the One Health framework, because they cause significant impacts on the health of humans and animals. The investigation of potentially zoonotic fungi in wild animals is fundamental for understanding the ecoepidemiologic dynamics, so this study aimed to detect Candida spp. in captive collared peccaries bred in naturalistic enclosures in the Brazilian Amazon. Swabs from the oral cavity were collected and processed according to classical microbiology techniques. Thirty animals were evaluated, and 93% (28/30) had at least one Candida species detected. A total of 42 Candida spp. isolates were recovered, with five identified species: Candida albicans, Candida krusei, Candida parapsilosis, Candida glabrata, and Candida tropicalis. One Candida isolate remained unidentified. These findings highlight the role of collared peccaries as potential reservoirs of opportunistically pathogenic yeasts and emphasize the importance of active surveillance of microbial diversity in wild animals.

Tracheoesophageal fistula (TEF) is a rare but devastating complication of mechanical ventilation and tracheostomy, classically described as a late sequela of prolonged airway instrumentation. Patients with severe burn injury and inhalation injury represent a uniquely vulnerable population due to airway mucosal ischemia, thermal injury, and impaired tissue healing. We report a case of fulminant posterior tracheal wall failure with early TEF formation occurring within days of tracheostomy in a 75-year-old patient with extensive full-thickness facial burns following thermal inhalation injury from hot liquid exposure. The clinical course was marked by early ventilatory warning signs including intermittent ventilator dyssynchrony, transient reductions in tidal volumes, and progressive cuff leak prior to catastrophic airway failure. Bronchoscopy demonstrated a large posterior tracheal defect with migration of the tracheostomy tube into the esophagus. Given the extent of injury and limited reconstructive options, care was transitioned to a comfort-focused approach. This case highlights an early airway failure phenotype that differs from the traditional delayed presentation of TEF and underscores the importance of heightened clinical vigilance. Persistent cuff leaks or unexplained ventilatory instability in patients with inhalation injury should prompt urgent airway reassessment to allow early intervention before irreversible airway disruption occurs.