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Rapid innovations for treatment and diagnostic procedures in advanced prostate cancer have led to improved outcomes, although uncertainty remains regarding the best management approach in many clinical situations. The 2019 Advanced Prostate Cancer Consensus Conference (APCCC) addressed these areas of uncertainty with a multidisciplinary international expert panel. A total of 57 experts voted on 123 carefully prepared questions. Primary analysis for APCCC 2019 showed consensus (≥75% agreement on one answer) for 33 questions. Here we investigate whether agreement with the consensus answers differed according to medical discipline and region of practice. Overall there was no compelling evidence for group differences in agreement with the consensus answers: expert subgroups differed no more than could be expected by chance due to differences between individual experts. All questions for which consensus was achieved had at least 50% agreement in each expert subgroup. Furthermore, the set of consensus questions changed only moderately if one of the subgroups was excluded from the panel. The identification of consensus questions and answers at APCCC 2019 appeared to be robust to the composition of the panel and well supported. Patient summary: The Advanced Prostate Cancer Consensus Conference (APCCC) addresses areas of uncertainty with a multidisciplinary panel of experts. We analyzed the decisions of these panelists and grouped them by their medical discipline and their region of practice. For all questions for which consensus (agreement ≥75%) was found, at least 50% of each group agreed, indicating widespread support of these answer choices. This finding strengthens the consensus achieved at APCCC 2019 and provides further guidance for clinicians.

Background:Innovations in treatments, imaging and molecular characterisationhave improved outcomes for people with advanced prostate cancer; however, many aspectsof clinical management are devoid of high-level evidence. At the Advanced Prostate CancerConsensus Conference (APCCC) 2019, many of these topics were addressed, and consensuswas not always reached. The results from clinical trials will most reliably plus the gaps.Methods:An invited panel of 57 experts voted on 123 multiple-choice questions on clinicalmanagement at APCCC 2019. No consensus was reached on 88 (71.5%) questions definedas

Aim of the work.: Studies describing the epidemiology of vasculitis in the Middle East and Africa are limited. The aim of this multi-centre study is to describe the distribution and outcome of vasculitic syndromes among Egyptian vasculitis patients seen by rheumatologists. Patients and Methods: The files of patients diagnosed with vasculitis between January 2002 and December 2016 were reviewed and were classified according to The Chapel Hill Consensus Conference on the Nomenclature of Systemic Vasculitis CHCC 2012 and disease- specific criteria. The vasculitis damage index (VDI) was calculated for all patients at the last visit. Results: Six hundred and thirty patients with ages ranging from of 9 months-74 years, including 264 (41.9%) males and 366 (58.1%) females were studied. Vasculitis associated with hepatitis C virus (HCV) infection was detected in 151 (24%), Behçet’s disease in 148 (23.5%), Immunoglobulin A vasculitis in 101 (16%), vasculitis associated with systemic lupus erythematosus in 93 (14.8%), Takayasu’s arteritis in 33 (5.2%), Kawasaki’s disease in 22 (3.5%) patients, respectively. Other vasculitic syndromes were uncommon and each accounted for less than 2% of the studied cases. The VDI ranged from 0 to 13. Only 109/630 (17.3%) patients had no vasculitis-related damage (VDI = 0). Mortality was recorded in 36 (5.7%) patients; out of these, 27 deaths were vasculitis-related. Conclusion: HCV-associated vasculitis and Behçet’s disease were the most frequently diagnosed vasculitic syndromes. Keywords: Vasculitis damage index, Vasculitis, Behçet’s disease, HCV-associated vasculitis, Egypt

The Brugada syndrome (BrS), one of the most devastating causes of sudden cardiac death in relatively young patients with apparently normal hearts, was originally termed in 1992. According to the recent consensus conference of J wave syndromes in 2016, only spontaneous type 1 Brugada-ECG pattern is the basis for the diagnosis of BrS. Mutations which affect cardiac ion currents have been linked to the syndrome, however strong evidence of link to the disease has been established only for the cardiac sodium channel gene SCN5A. Because all mutations thus far identified in SCN5A display an autosomal dominant mode of transmission, males and females would be expected to inherit the defective gene equally, however, Brugada-ECG pattern phenotype is 8 to 10 times more prevalent in men than in women. Moreover, malignant BrS is surprisingly uncommon in females, representing less than 10% of the patient population with arrhythmic events (AEs). This explains the difficulty of accurately comparing the clinical, ECG, electrophysiologic and genetic characteristics of males and females with BrS and AEs. In the present chapter we will review the main sex differences in BrS patients.

Primary systemic vasculitides are classified according to their clinical, serological, and pathological features. The Chapel Hill Consensus conference updated the most recent nomenclature criteria of the classification in 2012. Vasculitis is best classified based on the size of the involved vessels into large, medium, and small vessel disease. Small vessel vasculitis (SVV) that includes glomerulonephritis is by far the most frequent vasculitic lesion in the kidney, and the defining renal lesion is a necrotizing crescentic glomerulonephritis. In this chapter, we review the biomarkers in small vessel vasculitis that affect the kidney, with emphasis on ANCA-associated vasculitis (AAV).

the acute respiratory distress syndrome (ARDS) was first characterized in 1967 in a series of 12 patients with hypoxemia, tachypnea, and decreased respiratory system compliance. Following this original description, numerous definitions have been developed to identify patients with ARDS. Most recently, the Berlin definition of ARDS was published in 2012 with the aim of improving upon the feasibility, reliability, and validity of the previous American–European Consensus Conference definition. Through a novel, iterative approach, the Berlin definition was developed and refined using a patient-level meta-analysis of clinical trials and epidemiologic data. The final result of this process was a definition that utilizes readily available clinical, radiographic, and laboratory data to identify patients with ARDS. The Berlin definition stratifies patients by degree of hypoxemia, to better link physiology to patient outcomes and optimize the definition’s predictive validity for mortality. Despite these advancements, a number of limitations to the use of the Berlin definition remain. These limitations include the challenge of accurate radiographic interpretation, an inability to use these criteria in resource-limited settings, and a lack of specificity of the Berlin definition for the pathologic gold standard of ARDS, diffuse alveolar damage. Most importantly, ARDS remains underrecognized by clinicians, thereby limiting the appropriate use of evidence-based adjunctive therapies. Future work must focus on biomarkers to better identify patients with ARDS, thus facilitating improved clinical care and the development of targeted therapeutics.

The term cardiorenal syndrome (CRS) includes a broad spectrum of diseases in which the heart and kidney are involved acutely or chronically. According to the recent definition proposed by consensus conference of Acute Dialysis Quality Initiative Group (1), CRS has been used to define different clinical conditions in which heart and kidney dysfunction overlap. The heart and kidney are involved in basic physiology, and their functions are strictly linked. Although the heart provides nourishing and oxygen-rich fluids to all body areas, the kidney provides fluid, electrolytes, and acid-base homeostasis together with erythropoietin synthesis and vitamin D activation. CRS complexity must be explained starting with its pathogenesis and epidemiology and then by analyzing diagnostic, clinical, and therapeutic pathways. A clear classification of CRS is crucial because its wide, correct application is required, presenting an important challenge for nephrologists and cardiologists which have to contaminate their own fields of applications. This contamination could create common frontiers between cardiology and nephrology, contributing to a holistic and complete picture of patients. An effective classification of CRS has been proposed in a consensus conference by the Acute Dialysis Quality Group (1) in 2008. This classification essentially divides CRS in two main groups, cardiorenal and renocardiac CRS, on the basis of primum movens of disease (cardiac or renal); both cardiorenal and renocardiac CRS then are divided into acute and chronic, according to the disease's onset. Type – 5 of CRS integrates all cardiorenal involvement induced by systemic disease.

In the summer of 2016, delegates from the German Respiratory Society, the German Society of Cardiology and the German Society of Pediatric Cardiology met in Cologne, Germany, to define consensus-based practice recommendations for the management of patients with pulmonary arterial hypertension (PAH). These recommendations were built on the 2015 European Pulmonary Hypertension guidelines and included new evidence, where available. The treatment algorithm for PAH was modified based on the observation that there are now many patients diagnosed with IPAH who are at an advanced age and have significant cardiopulmonary comorbidities. For patients newly diagnosed with classic forms of PAH, i.e. younger patients without significant cardiopulmonary comorbidities, the consensus-based recommendation was to use initial combination therapy as the standard approach. The use of monotherapies was no longer considered appropriate in such patients. The choice of treatment strategies should be based on the risk assessment as proposed in the European guidelines. In patients presenting with a low or intermediate risk, oral combination therapy with endothelin receptor antagonists and phosphodiesterase-5 inhibitors or soluble guanylate cyclase stimulators, respectively, should be used. In high-risk patients, triple combination therapy including a subcutaneous or intravenous prostacyclin analogue should be considered. For patients who suffer from PAH and significant cardiopulmonary comorbidities, initial monotherapy is recommended and the use of combination therapies should be considered on an individual basis. The latter recommendations are based on the scarcity of evidence supporting the use of combination therapy and the higher risk of drug-related adverse events in such patients.

Background Several gray areas and controversies exist concerning the management of pulmonary ground-glass opacities (GGOs), and there is a lack of consensus among clinicians on this topic. One of the main aims of the Italian Society of Thoracic Surgery is to promote education and research, so we decided to perform a survey on this topic to estimate current trends in practice in a large sample of thoracic surgeons. Methods A total of 160 thoracic surgeons responded, namely, completed our questionnaire (response rate, 53%; 160 of 302). The survey was composed of 36 questions divided into six subsections: (1) demographic characteristics of the respondents; (2) terminology and taxonomy; (3) radiologic and radiometabolic evaluation; (4) diagnostic approach and indications for surgery; (5) surgical management; and (6) radiologic surveillance. Results We observed some divergence of opinion regarding the definition of mixed GGOs, the role of 18F fluorodeoxyglucose positron emission tomography and computed tomography scans, indications for nonsurgical biopsy, intraoperative techniques for localizing GGOs, indications for surgery, extension of lung resection and lymph node dissection according to the radiologic scenario, use of intraoperative frozen section analysis, and radiologic surveillance of pure GGOs. Conclusions This topic warrants more investigation in the future. An upcoming consensus conference of Italian Society of Thoracic Surgery experts (also open to experts in other specialties) could provide updated indications for GGO management based on the literature, expert opinions, and the results of the present survey.

Intrathecal drug delivery has been a valuable treatment for severe refractory pain conditions. However, despite the growing evidence about and success of implanted drug delivery, limitations such as variations in clinical practices exist. Fortunately clinical practice guidelines, such as the Polyanalgesic Consensus Conference recommendations, provide appropriate care based on the best available scientific evidence and broad consensus.

Emergencies span all social and specialty boundaries, making an integrated and cross-cutting approach to the management of acutely ill and injured patients essential. Most low income countries lack emergency care systems, and thus suffer the highest rates of morbidity and mortality from acute disease. The second African Federation for Emergency Medicine Consensus Conference was held in November, 2013, in Cape Town, South Africa. Workgroups included: Out of Hospital Care, Emergency Care Integration into Current Health Systems, and Documenting the Regional Burden of Acute Disease. One hundred thirty-five leaders in acute and emergency care representing 32 different countries attended the meeting. Workgroups were tasked with the generation of candidate frameworks to facilitate advocacy, scientific development, and future interventions in these three key areas.

The 2nd International Consensus Conference for Breast Cancer in Young Women (BCY2) took place in November 2014, in Dublin, Ireland organized by the European School of Oncology (ESO). Consensus recommendations for the management of breast cancer in young women (BCYW) were updated from BCY1 with incorporation of new evidence to inform the guidelines, and areas of research priorities were identified. This manuscript summarizes these international consensus recommendations, which are also endorsed by the European Society of Breast Specialists (EUSOMA).

Publisher Summary This chapter presents the diagnosis and treatment guidelines for migraine developed by the American Academy of Neurology (AAN). These guidelines are discussed and additional evidence is included based on the new studies that have become available since their initial publication. In addition, the European Consensus Conference recently established evidence-based treatment guidelines for the treatment of trigeminal autonomic cephalalgias. These guidelines are also discussed as they are the only evidence-based guidelines available for the treatment of these primary headache disorders. The therapeutic and diagnostic guidelines presented in this chapter represent the most exhaustive, rigorous, and recent in the field of headache. They represent a systematic evaluation of the evidence base for the acute and prophylactic treatment of migraine and trigeminal autonomic cephalalgias generated by international experts in the field of headache medicine. The variability in diagnosis and appropriate treatment of primary headache disorders is wide and it is the intention that these specific guidelines, if systematically and appropriately implemented in clinical practice, will improve the quality, appropriateness, and cost-effectiveness of the care of patients with headache.

Chronic infection with hepatitis C virus (HCV) is a dynamic disease from a biochemical perspective because transaminase levels fluctuate and may even fall within normal ranges at times. Although most patients with this disease have elevated alanine aminotransferase (ALT) levels, up to 46% of cases have persistently normal serum ALT levels despite the presence of HCV RNA. Until recently, HCV patients with normal ALT levels were not considered for treatment because it was believed that this indicated that hepatic lesions were absent. The 1997 consensus conference did not recommend HCV treatment for patients with normal transaminase levels. At the consensus conference of 2002, expert opinions regarding the site of the biopsy and the indications for treatment of patients with APN were divided. The following aspects of the management of APN patients are still the subject of debate. For how long should potential APN patients be monitored and at what intervals should analyses be done to determine whether they have APN? Most protocols define APN as at least three normal ALT values over a period of not less than 6 months. However, elevation of ALT levels may be delayed for 12 months in up to 21% of cases. The shorter the follow-up period, the greater the possibility of misdiagnosis of patients.

Publisher Summary Restless legs syndrome (RLS) and periodic limb movements (PLM) have been linked since the 1960s when Lugaresi, and his colleagues discovered that most patients with RLS suffer from periodic limb movements in sleep (PLMS). While highly associated, however, they do not appear to be merely alternate forms of one central neural process. Either can exist in a person without the other. Evidence suggests that RLS is only the most common condition associated with PLM. As recently defined by a consensus conference at the NIH held in conjunction with the International RLS Study group (IRLSSG), RLS is a clinical condition in which cognitively intact adult patients complain of four key symptoms. In brief, these are: (1) an urge to move, associated with abnormal sensation; (2) induction or aggravation by rest; (3) relief with activity; and (4) intensification at later phases of the normal day/night cycle (evening and night). While these symptoms are necessary to define RLS, there are mimics such as leg cramps or some polyneuropathic discomforts that can also satisfy these criteria and must be separately distinguished from RLS.