CAP TODAY Pathology/Laboratory Medicine/Laboratory Management
Editor: Deborah Sesok-Pizzini, MD, MBA, professor, Department of Clinical Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, and chief, Division of Transfusion Medicine, Children’s Hospital of Philadelphia.
WHO declares global emergency: a review of 2019 novel coronavirus
April 2020—An outbreak of pneumonia occurred in Wuhan, Hubei province, China, in December 2019. A novel coronavirus was identified as the causative agent and named SARS-CoV-2 by the World Health Organization (WHO). The disease, COVID-19, is considered a relative of severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). SARS-CoV-2–infected patients presented with a dry cough, dyspnea, fever, and bilateral lung infiltrates. The first cases were linked to a wholesale seafood and live animal market. The majority of infected patients spontaneously resolved. However, there were fatal complications, including organ failure, septic shock, pulmonary edema, severe pneumonia, and acute respiratory distress syndrome, in some people. The authors reviewed the current state of the COVID-19 outbreak, including the WHO declaration of a public health emergency of international concern on Jan. 30. The COVID-19 spread poses a high risk to countries with vulnerable health systems. The WHO Emergency Committee has focused on stopping the spread of SARS-CoV-2 through early detection, isolation, prompt treatment, and a system to track contacts. Other objectives include ascertaining the clinical severity and extent of transmission and optimizing potential treatments, while minimizing the economic impact of the virus. In response to this, the European Union mobilized research funds for public health preparedness and response, while U.S.-based companies launched COVID-19 test kits for use in the research setting. In addition, the United States suspended entry of immigrants and nonimmigrants into the country who had traveled from high-risk zones in an effort to minimize spread of the virus. Few studies define the characteristics of COVID-19, and the mechanism of spread is uncertain. Health care officials and others are concerned that human-to-human transmission may be occurring during the asymptomatic incubation period, which is estimated to be between two and 10 days. Several agencies, including WHO and the Centers for Disease Control and Prevention, have issued advice on further preventing spread of the virus. Research is required to help define the exact mechanism of human-to-human and animal-to-human transmission to facilitate the development of a virus-specific vaccine.
Sohrabi C, Alsafi Z, O’Neill N, et al. World Health Organization declares global emergency: A review of the 2019 novel coronavirus (COVID-19). Int J Surg. 2020;76:71–76.
Correspondence: Niamh O’Neill at niamh@ijspg.com
A four-group urine risk classifier for predicting outcomes in prostate cancer
A critical step in managing prostate cancer is performing a risk assessment for progression at the time of diagnosis. This helps inform the best course of treatment for localized cancer and predicts the likelihood of progression. The classification for having low, intermediate, or high risk of prostate-specific antigen (PSA) failure after radical therapy is based on biopsy Gleason score, PSA level, and clinical stage. However, sampling issues with biopsies are a driver for developing a noninvasive urine test to predict aggressive prostate cancer. The authors set out to develop and test a urine classifier that could predict prostate cancer risk groups and disease progression. They developed a risk classifier using urine-derived extracellular vesicle RNA from 167 gene probes that were previously associated with prostate cancer progression. The final 36-gene classifier was known as the Prostate Urine Risk (PUR) signatures and further divided into four classifications: PUR-1 (normal tissue), PUR-2 (low risk), PUR-3 (intermediate risk), and PUR-4 (high risk). The model was applied to a test cohort of men on active surveillance (n = 87) for prostate cancer and a test cohort (n=177) for diagnostic evaluation. The results showed that each PUR signature was significantly associated with its corresponding risk category and could be used as a versatile predictor of cancer progression. Because PSA may not be sensitive or specific for detecting prostate cancer, there is a need for additional biomarkers to assist in the prebiopsy assessment of cancer. These data showed that PUR-4 and PUR-1 could predict intermediate or high-risk prostate cancer. The investigators also found that the PUR model worked well with patients on active surveillance monitored by PSA and biopsy and in patients monitored by multiparametric MRI. The authors concluded that PUR represents a new and versatile urine biomarker that may be used to predict aggressive prostate cancer and the need for further intervention in men being actively surveilled. They reported that the prognostic information generated could help reduce patient-elected radical intervention among men on active surveillance, which can be as high as 75 percent. However, additional studies using other longitudinal cohorts are necessary to further validate these findings.