Ten-year outcome of patients with very small abdominal aortic aneurysm

BACKGROUND: The long-term fate of very small abdominal aortic aneurysms (AAA) is not well known. METHODS: Forty-one patients with asymptomatic small AAA (range 25 to 40 mm) underwent ultrasonographic surveillance. RESULTS: The median follow-up period was 7.3 years. The median linear aneurysm expansion rate was 2.0 mm/year (range 0 to 8.4). Three patients experienced aneurysm rupture (7.3%) which resulted in 1 patient'death. Thirteen patients underwent aneurysm repair (31.7%) and 1 patient died postoperatively (7.7%). The survival rate at 10-year follow-up was 59.0%. The survival rate free from aneurysm rupture and repair at 10-year follow-up was 69.9%. The median time for occurrence of aneurysm rupture was 4.9 years (range 1.8 to 10.5) and the need for aneurysm repair was 4.5 years (range 1.4 to 10.4). CONCLUSIONS: The fate of very small AAA is to slowly enlarge in size, sometimes threatening the patient's life. These observations underline the importance of continuous surveillance and the potential benefits of any medical treatment in this patient population.     

Timing and detection of metachronous colorectal cancer

Background: Surveillance following surgery for colorectal cancer aims to detect treatable disease relapse or metachronous neoplasia. Metachronous cancers have been reported within a short duration of follow‐up, and may be due to missed lesions, seeding into polypectomy wounds or accelerated tumorigenesis related to genetic instability. The purpose of this study was to establish the timing and method of detection of metachronous cancers in a large population of patients in a surveillance database. Methods: This retrospective clinical study used patients with an elevated risk of colorectal neoplasia included in a colonoscopy‐based surveillance programme to identify those with two or more colorectal cancers, as well as the timing and method of detection of the tumours. Colonoscopy reports and histopathology results were reviewed to determine quality of bowel preparation, tumour location, and polypectomy data. Results: Fourteen (2.5%) of 569 patients with colorectal cancer developed metachronous malignant tumours, nearly half of which were identified within 3 years of follow‐up by surveillance colonoscopy or an interval faecal immunochemical test for globin. None of these had a previous polypectomy at the site of the second tumour, bowel preparation at the original colonoscopy was good in most cases, and no metachronous tumour occurred at a colonic flexure. Conclusion: Metachronous cancers can occur early during follow‐up after curative intent resection, and early colonoscopic surveillance may be warranted.     

Patient acceptance of active surveillance as a treatment option for low-risk prostate cancer

Study Type – Decision analysis (lacking sensitivity analysis) Level of Evidence 4 What’s known on the subject? and What does the study add? Active surveillance is a management strategy that offers patients the hope of avoiding the side effects associated with unnecessary treatment. This study identifies the resources required by men who choose to be on active surveillance to support them in their treatment decision.

OBJECTIVES

• ? To examine the decision‐making processes of men on active surveillance (AS).
• ? To identify the resources that men want to access to make, support and sustain them while on AS.

PATIENTS AND METHODS

• ? Three‐part survey developed for this study based on a qualitative study of 25 men on AS.
• ? Survey items explored: role men assumed with their physician in treatment decision‐making, factors influencing decision to go on AS, and resources required while on AS.
• ? Surveys mailed out to cross‐sectional sample of men on AS for less than 10 years.

RESULTS

• ? 27% of the 73 men reported assuming an active role in treatment decision‐making with their urologist, 41% a shared role and 32% a passive role.
• ? 82% of men reported being comfortable and 90% being satisfied with their decision to be on AS.
• ? 55% reported not being anxious about the cancer progressing while on AS.
• ? Urologist’s opinion, current age, and impact of treatment on urinary function were main factors influencing treatment decision.
• ? Information on future treatment options, non‐traditional treatments and diet considered most important resources.

CONCLUSIONS

• ? Results suggest that once men make a decision to go on AS, they are satisfied with their decision and few report being anxious about progression of cancer.
• ? Men are strongly influenced by the treating specialist in taking up AS.
• ? Additional information and psychological support resources are required for men on AS.

     

Understanding Pig and Poultry Trade Networks and Farming Practices Within the Pacific Islands as a Basis for Surveillance

Pacific Island countries have large pig and poultry populations. Yet little is known about patterns of contact between animals and how this influences disease spread in these islands. The objectives of this study were to examine farmer practices and the movements of pig and poultry within the Pacific Islands using questionnaires and social network analysis (SNA) tools to understand disease spread in the region. Questionnaire‐based surveys were conducted in Fiji, Papua New Guinea (PNG), Solomon Islands and Vanuatu with interviews of 310 pig farmers and 491 poultry farmers. Pacific Island farmers were found to have few animals (median = 7 pigs/farm, IQR 4–12), (median = 50 chicken/farm, IQR 23–52), (median = 10 ducks/farm, IQR 4–25), (median = 12 Muscovy ducks/farm, IQR 7–28) and a diversified number of species. A large proportion of farmers (44.6–61.3%) do not implement any preventive or control measures, yet the majority (80.6–88%) did not experience any animal diseases over the past 12 months. Most farmers never ask for veterinary care, never engage in laboratory testing and do not report when their animals show clinical signs. Many pig farmers (31.8%) trade within their communities only and sell (24.5%) directly to consumers which reduces the risk of diseases spreading. Our results show an association between farmers that report having had disease on their farm in the past 12 months and movements of animals on and off their farms. The capitals of the studied provinces in PNG, Vanuatu and Solomon Islands were identified as the most connected nodes of both pig and poultry trade, while Fiji networks appeared much less connected. Our study found that farmer practices increased the risk of disease spread, but this was currently limited by trading practices. The SNA results serve as a basis for more targeted disease surveillance and better use of available resources for disease prevention and control.     

SURVEILLANCE CAN BE THE STANDARD OF CARE FOR STAGE I NONSEMINOMATOUS TESTICULAR TUMORS AND EVEN HIGH RISK PATIENTS

PURPOSE: We investigate the results of a surveillance program for stage I nonseminomatous germ cell tumors to validate a surveillance policy, and furthermore improve it by analyzing diagnostic instruments and identifying prognostic factors for relapse. MATERIALS AND METHODS: From 1982 to 1994, 90 patients with stage I nonseminomatous germ cell tumors entered a surveillance protocol after orchiectomy. Patients with relapse were treated with cisplatin based chemotherapy. A statistical analysis of possible prognostic factors for relapse was performed. RESULTS: Relapse occurred in 23 (26%) patients. Disease specific survival was 98.9%, and 1 patient died of tumor. Most relapses were located in retroperitoneal lymph nodes only (78%). Tumor markers were the most important indicators of relapse. However, in 22% of patients with relapse abdominal x-ray of lymphangiographic contrast showed the first sign of relapse. Computerized tomography located all but 1 relapse. Vascular invasion (p = 0.0001), tumor size (p = 0.0341) and presence of immature teratoma (p = 0.0154) were significantly predictive of relapse with the multivariate analysis, percentage embryonal carcinoma only by univariate analysis (p = 0.032). The relapse rate was highest (52%) when vascular invasion was present. CONCLUSIONS: With surveillance for stage I nonseminomatous germ cell tumors, excellent treatment results can be achieved that are comparable to primary retroperitoneal lymph node dissection. Tumor markers and computerized tomography are highly reliable for detecting relapse. Lymphangiography is still of staging value. Pathological factors may influence the choice of adjuvant treatment. However, relapse risks of 50% to 60% are maximally achieved with presently available prognostic factors, and so sparing morbidity of adjuvant treatment by a surveillance protocol remains a feasible option even in these patients.     

Validation of a prediction model for low volume/low grade cancer: application in selecting patients for active surveillance

PURPOSE: We previously demonstrated that assessment of the number of positive cores, tumor length in a core, Gleason score and prostate volume significantly enhanced the accuracy of a prediction model for low volume/low grade cancer in men who had undergone extended biopsy. To determine the validity of the model, we applied it to an independent population of men with prostate cancer. MATERIALS AND METHODS: The study group included 170 men who had undergone radical prostatectomy without neoadjuvant therapy. In all cases, prostate cancer was diagnosed on only 1 positive core of a 10-core extended biopsy. We assessed the accuracy of the model, which consists of tumor length less than 2 mm, Gleason score 3+4 or less and prostate gland volume greater than 50 cc in predicting the occurrence of low volume/low grade cancer (defined as tumor volume less than 0.5 cc, no Gleason grade 4 or 5 disease, and organ confined disease). RESULTS: Of the patients 101 (59.4%) had low volume/low grade cancer. Our model using all 3 previously mentioned variables had the highest performance, demonstrating a positive predictive value of 70.4% (88 of 125), a negative predictive value of 71.1% (32 of 45) and a diagnostic accuracy of 70.6% (120 of 170). This model performed better than a model based on tumor length only (positive predictive value, negative predictive value and diagnostic accuracy 68.1%, 57.9% and 64.7%, respectively) or a model based on tumor length and Gleason score (positive predictive value, negative predictive value and diagnostic accuracy 70.0%, 60.0% and 66.5%, respectively). CONCLUSIONS: This study validates that our model with a combination of tumor length, Gleason score and prostate volume is predictive for low volume/low grade cancer in an independent population of men who demonstrated only 1 positive core in an extended biopsy. This model can be used as a tool for selecting men for active surveillance.     

局限性肾癌的外科治疗进展

在过去三十年,随着横断面影像学的发展及在临床上的应用增多,使偶然发现的肾肿块数量不断增加,导致无症状、局限性、肾小肿块发生率随之升高。对于临床上发现的局限性肾癌,长期以来根治性肾切除一直是传统治疗的"金标准",但随着早期肾癌检出率的增高以及许多新技术和新观念的出现,应该对肾癌的治疗方式进行重新评估。     

Serological Evidence Indicates that Foot‐and‐Mouth Disease Virus Serotype O,C and SAT1 are most Dominant in Eritrea

Foot‐and‐mouth disease (FMD) is endemic in Eritrea and in most parts of Africa. To be able to control FMD using vaccination, information on the occurrence of various foot‐and‐mouth disease serotypes in Eritrea is needed. In this cross‐sectional study, 212 sera samples were collected from FMD infected and recovered animals in Eritrea. These samples were tested for the presence of antibodies against FMD non‐structural proteins (NSP) and neutralizing antibodies against six of the seven (all but SAT 3) serotypes of FMD virus (FMDV). Of these, 67.0% tested positive to non‐structural protein antibodies in the FMD NS ELISA. By virus neutralization, FMDV serotype O antibodies were shown to be the most dominant (approximately 50%). Virus neutralization test results indicate that infection with serotype C and SAT 1 might have occurred, although there are no reports of isolation of these two serotypes. Because the samples were not randomly selected, further random serological surveillance in all age group animals is necessary both to estimate the prevalence of FMD in the country and to confirm the serological results with serotype C and SAT 1.     

Epidemiology and spatio‐temporal analysis of West Nile virus in horses in Spain between 2010 and 2016

During the last decade, West Nile virus (WNV ) outbreaks have increased sharply in both horses and human in Europe. The aims of this study were to evaluate characteristics and spatio‐temporal distribution of WNV outbreaks in horses in Spain between 2010 and 2016 in order to identify the environmental variables most associated with WNV occurrence and to generate high‐resolution WNV suitability maps to inform risk‐based surveillance strategies in this country. Between August 2010 and November 2016, a total of 403 WNV suspected cases were investigated, of which, 177 (43.9%) were laboratory confirmed. Mean values of morbidity, mortality and case fatality rates were 7.5%, 1.6% and 21.2%, respectively. The most common clinical symptoms were as follows: tiredness/apathy, recumbency, muscular tremor, ataxia, incoordination and hyperaesthesia. The outbreaks confirmed during the last 7 years, with detection of WNV RNA lineage 1 in 2010, 2012, 2013, 2015 and 2016, suggest an endemic circulation of the virus in Spain. The spatio‐temporal distribution of WNV outbreaks in Spain was not homogeneous, as most of them (92.7%) were concentrated in western part of Andalusia (southern Spain) and significant clusters were detected in this region in two non‐consecutive years. These findings were supported by the results of the space–time scan statistics permutation model. A presence‐only MaxEnt ecological niche model was used to generate a suitability map for WNV occurrence in Andalusia. The most important predictors selected by the Ecological Niche Modeling were as follows: mean annual temperature (49.5% contribution), presence of Culex pipiens (19.5% contribution), mean annual precipitation (16.1% contribution) and distance to Ramsar wetlands (14.9% contribution). Our results constitute an important step for understanding WNV emergence and spread in Spain and will provide valuable information for the development of more cost‐effective surveillance and control programmes and improve the protection of horse and human populations in WNV ‐endemic areas.     

Herd‐level prevalence and incidence of porcine epidemic diarrhoea virus (PEDV) and porcine deltacoronavirus (PDCoV) in swine herds in Ontario,Canada

Porcine epidemic diarrhoea virus (PEDV ) and porcine deltacoronavirus (PDC oV) were first identified in Canada in 2014. Surveillance efforts have been instrumental in controlling both diseases. In this study, we provide an overview of surveillance components for the two diseases in Ontario (Canada), as well as PEDV and PDC oV incidence and prevalence measures. Swine herds located in the Province of Ontario, of any type, whose owners agreed to participate in a voluntary industry‐led disease control programme (DCP ) and with associated diagnostic or epidemiological information about the two swine coronaviruses, were eligible to be included for calculation of disease frequency at the provincial level. PEDV and PDC oV data stored in the industry DCP database were imported into the R statistical software and analysed to produce weekly frequency of incidence counts and prevalence counts, in addition to yearly herd‐level incidence risk and prevalence between 2014 and 2016. The yearly herd‐level incidence risk of PEDV , based on industry data, was 13.5%, 3.0% and 1.4% (95% CI : 11.1–16.2, 2.0–4.2, 0.8–2.3), while the yearly herd‐level incidence risk of PDC oV was 1.1%, 0.3%, and 0.1% (95% CI : 0.5–2.2, 0.1–0.9, 0.0–0.5), for 2014, 2015 and 2016, respectively. Herd‐level prevalence estimates for PEDV in the last week of 2014, 2015 and 2016 were 4.4%, 2.3% and 1.4%, respectively (95% CI : 3.1–6.0, 1.5–3.3, 0.8–2.2), while herd‐level prevalence estimates for PDC oV in the last week of 2014, 2015 and 2016 were 0.5%, 0.2% and 0.2%, respectively (95% CI : 0.1–1.2, 0.0–0.6, 0.0–0.6). Collectively, our results point to low and decreasing incidence risk and prevalence for PEDV and PDC oV in Ontario, making both diseases possible candidates for disease elimination at the provincial level.