Introduction: The objective is to provide guidance on the role of active surveillance (AS) as a management strategy for low-risk prostate cancer patients and to ensure that AS is offered to appropriate patients assessed by a standardized protocol. Prostate cancer is often a slowly progressive or sometimes non-progressive indolent disease diagnosed at an early stage with localized tumours that are unlikely to cause morbidity or death. Standard active treatments for prostate cancer include radiotherapy (RT) or radical prostatectomy (RP), but the harms from over diagnosis and overtreatment are of a significant concern. AS is increasingly being considered as a management strategy to avoid or delay the potential harms caused by unnecessary radical treatment. Methods: A literature search of MEDLINE, EMBASE, the Cochrane library, guideline databases and relevant meeting proceedings was performed and a systematic review of identified evidence was synthesized to make recommendations relating to the role of AS in the management of localized prostate cancer. Results: No exiting guidelines or reviews were suitable for use in the synthesis of evidence for the recommendations, but 59 reports of primary studies were identified. Due to studies being either non-comparative or heterogeneous, pooled meta-analyses were not conducted. Conclusion:The working group concluded that for patients with low-risk (Gleason score ≤6) localized prostate cancer, AS is the preferred disease management strategy. Active treatment (RP or RT) is appropriate for patients with intermediate-risk (Gleason score 7) localized prostate cancer. For select patients with low-volume Gleason 3+4=7 localized prostate cancer, AS can be considered.

Introduction: In non-small-cell lung cancer (nsclc), invasive mediastinal staging is typically used to guide treatment decision-making. Here, we present clinical practice guideline recommendations for invasive mediastinal staging in nsclc patients who have been staged T1–4, N0–3, with no distant metastases. Draft recommendations were formulated based on the best available evidence gathered by a systematic review and a consensus of expert opinion. The draft recommendations underwent an internal review by clinical and methodology experts, and an external review by clinical practitioners through a survey assessing the clinical relevance and overall quality of the guideline. Feedback from the internal and external reviews was integrated into the clinical practice guideline. In general, most clinical experts agreed with the guideline, approving it for methodologic rigour. More than 80% of the surveyed practitioners gave it a high quality rating. The expert reviewers also provided written comments, with some of the suggested changes being incorporated into the final version of the guideline. In the clinical practice guideline, invasive mediastinal staging of nsclc is recommended in all cases except those involving patients with normal-sized lymph nodes, negative combine positron-emission tomography and computed tomography, and peripheral clinical stage 1A tumour. When performing mediastinoscopy, 5 nodal stations (2R/L, 4R/L, and 7) should routinely be examined.

This study reports the first isolation of Candida dubliniensis from North American Indians. Of 39 healthy human hosts sampled, two had C. dubliniensis. Genotypic analysis identified polymorphisms in these strains and differences from two reference strains. Our results suggest that yeast populations from indigenous communities in North America may be unique.Candida dubliniensis is a newly described species with a close genetic similarity to the more common Candida albicans (9). Though C. dubliniensis has been recovered from several body sites in many human populations, it is most often recovered from the oral cavities of patients infected with human immunodeficiency virus (2,3,9). One hypothesis for the current global distribution of C. dubliniensis is the recent massive migrations of the human hosts, especially during the last century. If this hypothesis is correct, we expect that healthy human populations living in relative isolation should have no or very low percentages of C. dubliniensis. Furthermore, if such strains exist, their genotypes might be different from the genotypes found in other communities. Many aboriginal communities in North America are ideal populations to study to test this hypothesis.We sampled yeast populations from healthy human hosts in the Six Nations and New Credit reserves in southern Ontario, Canada. These reserves were established in 1847 by the British government and currently occupy an area of about 20,000 ha with a population of about 17,000. The ancestors of the residents of these reserves were living in the Great Lakes region for thousands of years, long before the discovery of the New World about 500 years ago (5). These populations have remained relatively isolated, in human population genetics terms, from new immigrants and from surrounding nonnative communities, before and after the establishment of these reserves about 150 years ago (5). Participation in our survey was voluntary (parents gave consent for their children) and based on their availability from April to June in 2002. A total of 39 healthy individuals were recruited and agreed to participate. Their ages ranged from 4 to 75 years. Most individuals spent almost all their time on the reserves. Each individual was sampled three times in 2002: mid-April, mid-May, and midJune. All hosts were healthy during the time of sampling, and none had human immunodeficiency virus infection before or during our sampling period. Sampling was done as described previously (4). A total of 351 samples were collected (three samples from three body sites from each of 39 hosts).Swabs and nail samples were directly deposited into microcentrifuge tubes containing 0.5 ml of sterile water. Each sample was vigorously vortexed, and liquid suspension was spread plated onto CHROMAgar Candida (CHROMAgar Company, Paris, France). Morphologically distinct green colonies from CHROMAgar plates were identified as either C. dubliniensis or C. albicans on the basis of carbohydrate metabolic profiles on API 20C strips (profiles typical of those for C. al...