Subsequent Surveillance Research Articles

Conservative approach in Peutz-Jeghers syndrome: Single-balloon enteroscopy and small bowel polypectomy.

To assess the usefulness of the balloon assisted enteroscopy in preventing surgical intervention in patients with Peutz-Jeghers syndrome (PJS) having a small bowel large polyps. Seven consecutive asymptomatic pts (age 15-38 years) with PJS have been collected; six underwent polypectomy using single balloon enteroscopy (Olympus SIF Q180) with antegrade approach using push and pull technique. SBE system consists of the SIF-Q180 enteroscope, an overtube balloon control unit (OBCU Olympus Balloon Control Unit) and a disposable silicone splinting tube with balloon (ST-SB1). All procedures were performed under general anesthesia. Previously all pts received wireless capsule endoscopy (WCE). Prophylactic polypectomy was reserved mainly in pts who had polyps > 15 mm in diameter. The balloon is inflated and deflated by a balloon control unit with a safety pressure setting range from -6.0 kPa to +5.4 kPa. Informed consent has been obtained from pts or parents for each procedure. Six pts underwent polypectomy of small bowel polyps; in 5 pts a large polyp > 15 mm (range 20-50 mm in diameter) was resected; in 1 patient with WCE negative, SBE was performed for previous surgical resection of gastrointestinal stromal tumors. In 2 pts endoscopic clips were placed due to a polypectomy. No surgical complication have been reported. SBE with resection of small bowel large polyps in PJS pts was useful to avoid gastrointestinal bleeding and emergency laparotomy due to intestinal intussusceptions. No gastrointestinal tumors were found in subsequent enteroscopic surveillance in all seven pts. In order surveillance, all pts received WCE, upper endoscopy, ileocolonoscopy every 2 years. No pts had extraintestinal malignant lesions. SBE was performed when WCE was positive for significant polyps (> 15 mm). The effective of prophylactic polypectomy of small bowel large polyps (> 15 mm) could be the first line treatment for conservative approach in management of PJS patients.

Association of Socioeconomic Position and Demographic Characteristics with Cardiovascular Disease Risk Factors and Healthcare Access among Adults Living in Pohnpei, Federated States of Micronesia.

Background. The burden of cardiovascular disease (CVD) is increasing in low-to-middle income countries. We examined how socioeconomic and demographic characteristics may be associated with CVD risk factors and healthcare access in such countries. Methods. We extracted data from the World Health Organization's STEPwise approach to surveillance 2002 cross-sectional dataset from Pohnpei, Federated States of Micronesia (FSM). We used these data to estimate associations for socioeconomic position (education, income, and employment) and demographics (age, sex, and urban/rural) with CVD risk factors and with healthcare access, among a sample of 1638 adults (25–64 years). Results. In general, we found significantly higher proportions of daily tobacco use among men than women and respondents reporting primary-level education (<9 years) than among those with postsecondary education (>12 years). Results also revealed significant positive associations between paid employment and waist circumference and systolic blood pressure. Healthcare access did not differ significantly by socioeconomic position. Women reported significantly higher mean waist circumference than men. Conclusion. Our results suggest that socioeconomic position and demographic characteristics impact CVD risk factors and healthcare access in FSM. This understanding may help decision-makers tailor population-level policies and programs. The 2002 Pohnpei data provides a baseline; subsequent population health surveillance data might define trends.

Barrett's oesophagus: Evidence from the current meta-analyses.

Guidelines have been published regarding the management of Barrett's oesophagus (columnar-lined oesophagus). These have examined the role of surveillance in an effort to detect dysplasia and early cancer. The guidelines have provided criteria for enrolment into surveillance and some risk stratification with regard to surveillance interval. The research basis for the decisions reached with regard to cancer risk is weak and this manuscript has examined the available data published from meta-analyses up to 25(th) April 2013 (much of which has been published since the guidelines and their most recent updates have been written). There were 9 meta-analyses comparing patients with Barrett's oesophagus to control populations. These have demonstrated that Barrett's oesophagus is more common in males than females, in subjects who have ever smoked, in subjects with obesity, in subjects with prolonged symptoms of gastro-oesophageal reflux disease, in subjects who do not have infection with Helicobacter pylori and in subjects with hiatus hernia. These findings should inform public health measures in reducing the risk of Barrett's oesophagus and subsequent surveillance burden and cancer risk. There were 8 meta-analyses comparing different groups of patients with Barrett's oesophagus with regard to cancer risk. These have demonstrated that there was no statistically significant benefit of antireflux surgery over medical therapy, that endoscopic ablative therapy was effective in reducing cancer risk that there was similar cancer risk in patients with Barrett's oesophagus independent of geographic origin, that the adenocarcinoma incidence in males is twice the rate in females, that the cancer risk in long segment disease showed a trend to be higher than in short segment disease, that there was a trend for higher cancer risk in low-grade dysplasia over non-dysplastic Barrett's oesophagus, that there is a lower risk in patients with Helicobacter pylori infection and that there is a significant protective effect of aspirin and statins. There were no meta-analyses examining the role of intestinal metaplasia. These results demonstrate that guidance regarding surveillance based on the presence of intestinal metaplasia, segment length and the presence of low-grade dysplasia has a weak basis, and further consideration should be given to gender and helicobacter status, ablation of the metaplastic segment as well as the chemoprotective role of aspirin and statins.

Inflammatory bowel disease cancer surveillance in a tertiary referral hospital: attitudes and practice

Physician adherence to guidelines for colorectal cancer (CRC) surveillance in inflammatory bowel disease (IBD) is often poor. This may lead to adverse patient outcomes and excess endoscopic workload. To assess the attitudes and practice of IBD specialists in a tertiary centre towards colonoscopic surveillance. First, a questionnaire evaluating attitudes and approach to CRC surveillance was issued to 36 clinicians at one tertiary referral hospital. Second, a retrospective audit of IBD surveillance colonoscopy practice over a 2-year period was performed. Questionnaire response rate was 97%. Sixty-nine per cent of respondents were aware of, and used, Australian guidelines. Surveillance was undertaken by all clinicians in patients with extensive colitis, 83% in patients with left-sided colitis and 51% in patients with proctitis. Seventy-six per cent used chromoendoscopy, and 47% took 10 to 20 random biopsies. Colectomy was considered appropriate in 0% for unifocal low-grade dysplasia, 35% for multifocal low-grade dysplasia and 83% for high-grade dysplasia. Sixty-six per cent would remove elevated dysplastic lesions endoscopically. The audit identified 103 surveillance colonoscopies in 81 patients. Chromoendoscopy was used in 21% of cases, and the median number of random biopsies was 13. Sixty-two per cent of colonoscopies were performed outside the guidelines in relation to colonoscopic frequency. Following colonoscopy, an appropriate recommendation for subsequent surveillance was documented in 40% of cases. Knowledge and practice of CRC surveillance in IBD vary among specialist clinicians and often deviate from guidelines. Many clinicians perform surveillance earlier and more frequently than recommended. These findings have implications for patient outcomes and workload.

Molecular Epidemiologic Trends of Diarrhea‐Causing Virus Infection From Clinical Specimens in Cheonan, Korea, in 2010–2012

The enteric viruses have high health significance in humans, ranging from poliomyelitis, hepatitis, and gastroenteritis to innocuous infections, and the human enteric viral infection is the one of the most common diseases during early childhood. This study was conducted from July 2010 to October 2012. We subjected 788 stool specimens using multiplex polymerase chain reaction (mPCR) tests that could simultaneously detect five enteric viruses, group A rotavirus (GAR), enteric adenovirus (EAdV), norovirus GI (NoV-GI), norovirus GII (NoV-GII), and human astrovirus (HAstV). The data were analyzed according to seasonality and patient age and sex. Two hundred and seventy specimens (34.3%) were positive, 276 viruses were detected in the 788 sample. The prevalence of GAR, EAdV, NoV-GI, NoV-GII, and HAstV infections in the 270 mPCR-positive specimens was 101 (36.6%), 28 (10.1%), 4 (1.4%), 132 (47.8%), and 11 (4.0%), respectively; six specimens (2.2%) contained double infections. NoV-GII and GAR infections occurred mainly in the winter and spring. We described the epidemiological analytic data of the diarrhea-causing viruses in the population of local society of Korea. These results could be helpful for the diagnosis and subsequent epidemiological surveillance of enteric viral infections.

Multiplex genetic cancer testing identifies pathogenic mutations in TP53 and CDH1in a patient with bilateral breast and endometrial adenocarcinoma

BackgroundGermline genetic testing for familial cancer syndromes is usually performed serially for the most likely genetic causes. In recent years the way genetic testing carried out has changed, as next generation sequencing now allows the simultaneous testing of multiple susceptibility genes at low costs.Case presentationHere, we present a female with bilateral breast cancer and endometrial adenocarcinoma. After simultaneous sequencing of 150 genes (890 kb) associated with hereditary cancer we identified pathogenic mutations in two high-penetrance genes, i.e. TP53 and CDH1 that would most likely not have been elucidated by serial screening of candidate genes.ConclusionAs the two mutated genes are located on different chromosomes and cause different cancer syndromes these findings had a tremendous impact not only on genetic counseling of the index patient and her family but also on subsequent surveillance strategies.

Lack Of Benefit From Surveillance PET-CT In Transformed Indolent Lymphoma (TrIL) In Complete Metabolic Remission (CMR) Following Therapy

BackgroundPatients (pts) with TrIL have inferior outcomes compared with de novo diffuse large B-cell lymphoma (DLBCL), and their optimum follow up is not well defined. We sought to determine the utility of surveillance PET-CT in pts with TrIL achieving CMR after primary therapy and identify patterns of relapse. MethodsWe performed a retrospective analysis of pts with TrIL treated at Peter MacCallum Cancer Centre between 2002 and 2012 who achieved CMR after primary therapy who had ³1 subsequent surveillance PET-CT. In the period analysed, departmental protocol recommended 6-monthly scans for pts in CMR for the first 2 years, then annually until 5 years after completion of therapy, if there was intention to intervene on detection of subclinical relapse. A positive scan suggested relapsed lymphoma, with true positive results requiring either biopsy confirmation or unequivocal scan progression. A false positive scan was refuted by biopsy and/or follow up showing resolution of areas of increased FDG uptake. A negative scan was interpreted as negative for relapsed lymphoma: true negatives had no clinical relapse and false negatives manifest relapse within three months from the date of the scan. Indeterminate scans were recorded if determination could not be made. ResultsThe cohort included 55 pts with TrIL: 38 underwent stem cell transplant (autologous, n= 37; allogeneic, n=1) as consolidation; 17 did not. (Table 1). After a median follow-up of 34 (range 3 – 101) months, the actuarial 3-year progression free (PFS) and overall survival (OS) were 77% (95% CI 62 – 86%) and 88% (75 – 94%) respectively. Multiple potential prognostic factors including IPI, stage, serum LDH, timing of transformation (simultaneous diagnosis of transformation versus delayed) and type of indolent histology were not predictive of PFS.Table 1Patient characteristicspatient characteristicsnumber of pts55median age (range) years59 (35 – 83)female (%)22 (40%)histologically transformed at initial diagnosis31 (56%)indolent histologyFLMALT/MZLCLL/SLLALCL46 (65%)5 (9%)3 (5%)1 (2%)IPI at transformation0 - 123 - 514 (27%)18 (34%)20 (39%)median serum LDH:ULN (range)1.03 (0 – 4.7)Extranodal sites0-1³3233 (62%)20 (38%)ECOG performance status0-1³3251 (95%)3 (5%)stageI-IIIII-IV11 (20%)44 (80%)B symptoms12 (23%)Table 2Results of surveillance PET-CT scans, by time elapsed since completion of therapy.0-6 mo6-12 mo12-18 mo18-24 mo24-36 mo36-48 mo48+ mototaltrue positives (subclinical)14110007true positives (suspected)12202108false positives11100104false negatives00000101indeterminate00610007true negatives3337262121105153total3644362323135180% of PET scans detecting subclinical relapse3%9%3%4%0%0%0%Of 180 surveillance PET-CT scans, there were 153 true negatives, 4 false positives, 1 false negative, 7 indeterminate and 15 true positives (Table 2). Considering indeterminate scans as false positives, the specificity of PET-CT for detecting relapse was 93%, sensitivity 93%, positive predictive value 54% and negative predictive value 99%. Of the 15 pts who experienced disease relapse, 7 (47%) were subclinical (i.e. detected by surveillance PET-CT scans) whilst 8 (53%) were suspected on the basis of clinical symptoms. Although 5% of scans in the first 2 years detected a subclinical relapse, all of these were either biopsy or clinically shown to be low-grade lymphoma. All 8 symptomatic relapses (at 2 – 42 months), in contrast were DLBCL. ConclusionIn pts with TrIL achieving CMR, PET-CT detects subclinical relapses of low-grade histology with high sensitivity but with a moderate false-positive rate. This is of limited clinical benefit as the initiation of further therapy in these circumstances is rarely based on imaging findings alone. In contrast, all DLBCL relapses in our cohort were accompanied by clinical symptoms. Thus, surveillance imaging of pts with TrIL achieving CMR is not indicated. PET-CT should be reserved for evaluation of suspected relapse only. [Display omitted] Disclosures:No relevant conflicts of interest to declare.

22-year longitudinal study of repetitive colonoscopy in patients with a family history of colorectal cancer

We report the outcomes of a long-term surveillance programme for individuals with a family history of colorectal cancer. The details of patients undergoing a colonoscopy having been referred on the basis of family history of colorectal cancer were entered prospectively into a database. Further colonoscopy was arranged on the basis of the findings. The outcomes assessed included incidence of cancer and adenoma identification at initial and subsequent colonoscopy. The records of 2,293 patients (917 men; median patient age: 51 years) were entered over 22 years, giving data on 3,982 colonoscopies. Eight adverse events (0.2%) were recorded. Twenty-seven cancers were found at first colonoscopy and thirteen developed during the follow-up period. There were significantly more cancers identified in those with more than one first-degree relative with cancer than in other groups (p=0.01). The number of adenomas identified at subsequent surveillance colonoscopies remained constant with between 9.3% and 12.0% of patients having adenomas that were removed. Two-thirds (68%) of patients with cancer and three-quarters (77%) with adenomas fell outside the British Society of Gastroenterology (BSG) 2006 guidelines. Repeated colonoscopy continues to yield significant pathology including new cancers. These continue to occur despite removal of adenomas at prior colonoscopies. The majority of patients with cancers and adenomas fell outside the BSG 2006 guidelines; more would have fallen outside the 2010 guidelines.

22-year longitudinal study of repetitive colonoscopy in patients with a family history of colorectal cancer

We report the outcomes of a long-term surveillance programme for individuals with a family history of colorectal cancer. The details of patients undergoing a colonoscopy having been referred on the basis of family history of colorectal cancer were entered prospectively into a database. Further colonoscopy was arranged on the basis of the findings. The outcomes assessed included incidence of cancer and adenoma identification at initial and subsequent colonoscopy. The records of 2,293 patients (917 men; median patient age: 51 years) were entered over 22 years, giving data on 3,982 colonoscopies. Eight adverse events (0.2%) were recorded. Twenty-seven cancers were found at first colonoscopy and thirteen developed during the follow-up period. There were significantly more cancers identified in those with more than one first-degree relative with cancer than in other groups (p=0.01). The number of adenomas identified at subsequent surveillance colonoscopies remained constant with between 9.3% and 12.0% of patients having adenomas that were removed. Two-thirds (68%) of patients with cancer and three-quarters (77%) with adenomas fell outside the British Society of Gastroenterology (BSG) 2006 guidelines. Repeated colonoscopy continues to yield significant pathology including new cancers. These continue to occur despite removal of adenomas at prior colonoscopies. The majority of patients with cancers and adenomas fell outside the BSG 2006 guidelines; more would have fallen outside the 2010 guidelines.

Molecular Epidemiology and Evolution of West Nile Virus in North America

West Nile virus (WNV) was introduced to New York in 1999 and rapidly spread throughout North America and into parts of Central and South America. Displacement of the original New York (NY99) genotype by the North America/West Nile 2002 (NA/WN02) genotype occurred in 2002 with subsequent identification of a novel genotype in 2003 in isolates collected from the southwestern Unites States region (SW/WN03 genotype). Both genotypes co-circulate to date. Subsequent WNV surveillance studies have confirmed additional genotypes in the United States that have become extinct due to lack of a selective advantage or stochastic effect; however, the dynamic emergence, displacement, and extinction of multiple WNV genotypes in the US from 1999–2012 indicates the continued evolution of WNV in North America.

Evaluation of a Cell Phone-Based Mobile Medical Documentation System During Operation Black Swan

Operation Black Swan, an Offshore Mass Rescue Operation exercise with the US Coast Guard (USCG), the cruise ship industry, the Bahamas, and numerous other stakeholders, was conducted on April 1- 5, 2013. Black Swan is a series of USCG exercises designed to prepare for a catastrophic incident at sea. The objective of this study was to test and evaluate a cell phone mobile medical documentation and tracking application as simulated patients were triaged, treated, and evacuated during Operation Black Swan. A cell phone based documentation and tracking system called the Pathfinder Rapid Assessment System (PRAS) was modified to store and transmit medical data. This mobile technology enables field observers to take pictures and add field notes on a cell phone, which are geocoded and time-date stamped into a command map for Emergency Operations Center (EOC) personnel to analyze as an incident unfolds. Simulated patients were evacuated from the Royal Caribbean “Monarch of the Seas” cruise ship via ship lifeboats to Freeport, Bahamas, where they were triaged on shore and transported to Rand Memorial Hospital in Freeport as medically indicated. Patients identified as needing evacuation to a higher level of care were aeromedically evacuated by the Florida Advanced Surgical and Transport Team (FAST) to Miami FL. An emergency physician accompanied simulated patients while abandoning ship in lifeboats and during on-shore triage, hospital treatment, and air evacuation by the FAST via a USCG C-130 aircraft. Assisted by a non-medical scribe, the physician provided information to the scribe for entry into the PRAS cell phone triage and abbreviated medical forms. Participants included the USCG, the Coast Guard Auxiliary, the cruise ship industry, Rand Memorial Hospital, the Bahamas National Emergency Management Agency, the Pathfinder Task Force, the FAST, and other stakeholders. The emergency physician assisted by a scribe utilized a cell phone-based triage form and triaged 56 patients in 42 minutes as documented by the software, transmitting initial triage criteria (respirations, pulse, mental status), triage tag status, 2 pictures of each victim with geotag and time/date stamp data. A more detailed cell phone-based medical form was utilized at the FAST team aeromedical staging site to create and transmit an abbreviated disaster patient movement record, which included patient name, vital signs, aeromedical evacuation movement precedence, critical care transport medical requirements, treatment, and equipment requirements. This exercise demonstrated the feasibility of using mobile medical documentation to provide real time information to an EOC or other agencies monitoring patient treatment, status, and location. The simplicity of this system and ability to store and transmit data allows for use in a 100% disconnected environment, can improve communication from responders, and can provide valuable real-time situational awareness for healthcare facilities, and EOCs. This technology can be utilized for rapid data collection during disasters, and can provide patient and responder rosters for subsequent surveillance or disaster research. The PRAS application should be further evaluated and tested in disaster exercises and during real-world disaster response and mass gathering events.

Review of economic evidence in the prevention and early detection of colorectal cancer.

This paper aims to systematically review the cost-effectiveness evidence, and to provide a critical appraisal of the methods used in the model-based economic evaluation of CRC screening and subsequent surveillance. A search strategy was developed to capture relevant evidence published 1999-November 2012. Databases searched were MEDLINE, EMBASE, National Health Service Economic Evaluation (NHS EED), EconLit, and HTA. Full economic evaluations that considered costs and health outcomes of relevant intervention were included. Sixty-eight studies which used either cohort simulation or individual-level simulation were included. Follow-up strategies were mostly embedded in the screening model. Approximately 195 comparisons were made across different modalities; however, strategies modelled were often simplified due to insufficient evidence and comparators chosen insufficiently reflected current practice/recommendations. Studies used up-to-date evidence on the diagnostic test performance combined with outdated information on CRC treatments. Quality of life relating to follow-up surveillance is rare. Quality of life relating to CRC disease states was largely taken from a single study. Some studies omitted to say how identified adenomas or CRC were managed. Besides deterministic sensitivity analysis, probabilistic sensitivity analysis (PSA) was undertaken in some studies, but the distributions used for PSA were rarely reported or justified. The cost-effectiveness of follow-up strategies among people with confirmed adenomas are warranted in aiding evidence-informed decision making in response to the rapidly evolving technologies and rising expectations.

Post-polypectomy colonoscopy surveillance: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

The following recommendations for post-polypectomy endoscopic surveillance should be applied only after a high quality baseline colonoscopy with complete removal of all detected neoplastic lesions.1 In the low risk group (patients with 1 - 2 tubular adenomas < 10 mm with low grade dysplasia), the ESGE recommends participation in existing national screening programmes 10 years after the index colonoscopy. If no screening programme is available, repetition of colonoscopy 10 years after the index colonoscopy is recommended (strong recommendation, moderate quality evidence). 2 In the high risk group (patients with adenomas with villous histology or high grade dysplasia or ≥10 mm in size, or ≥ 3 adenomas), the ESGE recommends surveillance colonoscopy 3 years after the index colonoscopy (strong recommendation, moderate quality evidence). Patients with 10 or more adenomas should be referred for genetic counselling (strong recommendation, moderate quality evidence). 3 In the high risk group, if no high risk adenomas are detected at the first surveillance examination, the ESGE suggests a 5-year interval before a second surveillance colonoscopy (weak recommendation, low quality evidence). If high risk adenomas are detected at first or subsequent surveillance examinations, a 3-year repetition of surveillance colonoscopy is recommended (strong recommendation, low quality evidence).4 The ESGE recommends that patients with serrated polyps < 10 mm in size with no dysplasia should be classified as low risk (weak recommendation, low quality evidence). The ESGE suggests that patients with large serrated polyps (≥ 10 mm) or those with dysplasia should be classified as high risk (weak recommendation, low quality evidence).5 The ESGE recommends that the endoscopist is responsible for providing a written recommendation for the post-polypectomy surveillance schedule (strong recommendation, low quality evidence).

Outbreak of ertapenem-resistant Enterobacter cloacae urinary tract infections due to a contaminated ureteroscope

Outbreaks of urinary tract infections (UTIs) due to contaminated ureteroscopes have been rarely reported. To report such an outbreak at a regional teaching hospital in southern Taiwan. From October to December 2010, ertapenem-resistant Enterobacter cloacae were identified from urine cultures of 15 patients who had undergone ureteroscopy prior to the infection. Three batches of surveillance cultures were obtained from the environmental objects and healthcare workers related to the procedures. Pulsed-field gel electrophoresis (PFGE) was used for bacterial typing. Antimicrobial susceptibility was assessed by disc diffusion and E-test methods. Polymerase chain reaction and sequencing were used to analyse β-lactamase genes. A total of 70 specimens were obtained during the first surveillance operation. One ertapenem-resistant E.cloacae was isolated from a ureteroscope. Although the disinfection protocols for ureteroscopes were revised and implemented, seven additional UTI cases were identified thereafter. The pathogen was identified from two subsequent surveillance cultures and was not eliminated until ethylene oxide sterilization was added to the disinfection protocol. PFGE revealed that all 15 isolates from the patients and the three isolates from the ureteroscope shared a common pattern with minor variance. Most isolates were resistant to gentamicin, levofloxacin, ceftriaxone, ceftazidime, and ertapenem. All isolates were susceptible to amikacin, imipenem, and meropenem. SHV-12 and IMP-8 genes were simultaneously identified in 16 of the 18 isolates. The outbreak of ertapenem-resistant E.cloacae was caused by a contaminated ureteroscope and was terminated by the implementation of a revised disinfection protocol for ureteroscopes.

Can glenohumeral joint isokinetic strength and range of movement predict injury in professional rugby league

ObjectiveTo isokinetically record shoulder strength scores and range of motion in a professional rugby league squad. To prospectively monitor injuries over a season looking for associations between measured variables and injury. DesignA cohort study design involving prospective screening of risk factors with subsequent injury surveillance. SettingUniversity Sports Science Laboratory and Professional Rugby League Club. ParticipantsAll players participating in the clubs reserve team squad for the 2011 season (n = 20). Main outcome measuresConcentric (Con) and eccentric (Ecc) peak torque values; ratio of Ecc internal rotation IR to Con external rotation ER, also known as the dynamic control ratio (DCR), shoulder range of IR and ER. ResultsEight players (36%) received a total of eleven injuries over the season. There were no statistically significant differences between injured and non-injured shoulders. IR range of movement was significantly lower in injured versus non-injured groups with left (p = 0.022) and right (p = 0.024). Left IR range of movement was predictive of injury using binary logistic regression (p = 0.046). No isokinetic strength parameters reached statistical significance (p > 0.05) for prediction of injury; however size effects were apparent for reduced con IR of the left shoulder and Ecc IR of both shoulders. ConclusionReduced shoulder IR range appears predictive of future shoulder injury although caution is drawn due to small participant numbers. Injury prevention strategies for rugby league players should include exercises to improve shoulder IR and possibly Ecc IR strength.

Donor-Derived Tuberculosis (TB) Infection in Lung Transplant Despite Following Recommended Algorithm

Donor-Derived Tuberculosis (TB) Infection in Lung Transplant Despite Following Recommended Algorithm

First cases of Schmallenberg virus in Italy: surveillance strategies.

Following the first report of Schmallenberg virus (SBV) in the brain of a dystocic goat foetus in 2012 in Northern Italy, immediate response actions were adopted to avoid the virus circulation. The brain tested positive by 2 different one-step real-time RT-PCR protocols; these results were also confirmed by partial sequencing of the viral genome. At that time this was the first detection of the new Orthobunyavirus genus within the Bunyaviridae family in Italy. An epidemiological investigation in the involved farm was carried out in collaboration with the CESME - National Reference Centre for the study and verification of Foreign Animal Diseases (Istituto Zooprofilattico Sperimentale dell'Abruzzo e del Molise 'G. Caporale', Italy). Epidemiological information on the flock was provided and analysed, whole blood and serum samples were also collected from all animals in the farm for both virological and serological investigations. All blood samples tested negative for SBV, whereas serological positive results were obtained by virus-neutralization (VN). Epidemiological investigations indicated the possible virus circulation in the area. The subsequent surveillance actions were mainly based on the standardization and reenforcement of passive surveillance protocols, a risk-based serological surveillance programme through VN and an entomological surveillance programme in the involved geographical areas were also put in place. Eventually SBV local circulation was confirmed by real time RT-PCR in 6 Culicoides pools, collected between September and November 2011 in 3 farms in the surroundings of the area of SBV outbreak.

Patterns of care for risk-reducing salpingo-oophorectomy (RRSO) for BRCA mutation carriers and subsequent surveillance

Patterns of care for risk-reducing salpingo-oophorectomy (RRSO) for BRCA mutation carriers and subsequent surveillance

Serum prostate‐specific antigen (PSA) concentration is positively associated with rate of disease reclassification on subsequent active surveillance prostate biopsy in men with low PSA density

To investigate the association between serum prostate-specific antigen (PSA) concentration at active surveillance (AS) entry and disease reclassification on subsequent AS biopsy ('biopsy reclassification') in men with low PSA density (PSAD). To investigate whether a clinically meaningful PSA threshold for AS eligibility/ineligibility for men with low PSAD can be identified based on risk of subsequent biopsy reclassification. We included men enrolled in the Johns Hopkins AS Study (JHAS) who had a PSAD of <0.15 ng/mL/g (640 men). We estimated the incidence rates (IRs; per 100 person years) and hazard ratios (HR) of biopsy reclassification (Gleason score ≥ 7, any Gleason pattern 4 or 5, ≥3 positive cores, or ≥50% cancer involvement/biopsy core) for categories of serum PSA concentration at the time of entry into AS. We generated predicted IRs using Poisson regression to adjust for age and prostate volume, mean percentage free PSA (ratio of free to total PSA) and maximum percentage biopsy core involvement with cancer. The unadjusted IRs (per 100 person years) of biopsy reclassification across serum PSA concentration at entry into JHAS showed, in general, an increase; however, the pattern was not linear with higher IRs in the group ≥ 4 to <6 ng/mL (14.2, 95% confidence interval [CI] 11.8-17.2%) when compared with ≥6 to <8 ng/mL (8.4, 95% CI 5.7-12.3%) but almost similar IRs when compared with the group ≥ 8 to <10 ng/mL (14.8, 95% CI 8.4-26.1%). The adjusted predicted IRs of reclassification showed a similar non-linear increase in IRs, whereby the rates around 4 ng/mL were similar to the rates around 10 ng/mL. Risk for biopsy reclassification increased non-linearly across PSA concentration in men with low PSAD, whereby no obvious clinically meaningful threshold could be identified. This information could be incorporated into decision-making for AS. However, longer follow-up times are needed to warrant final conclusions.

Endoscopic colorectal cancer screening provides long-lasting effect.

Endoscopic colorectal cancer screening provides long-lasting effect.