The Epidemiology of Malignant Melanoma during the First Two Years of the COVID-19 Pandemic: A Systematic Review

It is hypothesized that the COVID-19 pandemic had a major impact on the epidemiology of malignant melanoma owing to diminished screening, diagnostic, and treatment capacities, resulting in a more advanced stage at initial presentation. The goal of this study is to undertake a systematic analysis of all epidemiological and clinical data on the trends and patient outcomes with malignant melanoma during the ongoing pandemic. Records were identified from PubMed, Cochrane, and Web of Science, selecting a total of 39 articles, narrative reviews, and editorial letters, following the PRISMA guidelines. The vast majority of the studies were published in Europe (28/39), and North America (7/39). A total of 99,860 patients were analyzed during 2020 and 2021 of the COVID-19 pandemic, and it was observed that malignant melanoma TNM staging increased significantly compared to the pre-pandemic period. Before the pandemic, 25.88% of patients had TNM stage II or above, compared to 36.25% during 2020-2021. During the COVID-19 pandemic, the malignant melanoma Breslow depth index grew from 1.59 mm before 2020 to 1.86 mm in 2020 and 2021. Patients decreased by 19.58% in 2020 and 2021 compared to pre-pandemic numbers. The patient-loss ratio indicated lower screening activity and patient addressability to dermatology and plastic surgery departments with skin cancer concerns during the COVID-19 pandemic. This systematic study shows that the identification and management of malignant melanoma during the COVID-19 pandemic faced major challenges which should alert medical systems to the high number of patients with advanced disease stages who may need emergency treatment and become incurable.

Comparison of early pregnancy serum concentration of neopterin, neopterin/creatinine ratio, C-reactive protein, and chitotriosidase, in pregnant women with birth at term and spontaneous preterm birth

Inflammatory mechanisms are involved in achieving a normal pregnancy and in the development of certain pregnancy complications. These changes are more intense in pregnant women that suffer of pregnancy complications, such as spontaneous preterm birth (SPB). This study compared the course of inflammatory markers (IM) [neopterin (Neo), neopterin/creatinine ratio (Neo/Cre), C-reactive protein (CRP), and chitotriosidase (Chito)] serum concentration in the early pregnancy of women with birth at term (BT) and preterm birth (PB). IM concentration was measured in 90 sera sampled from 45 pregnancies with BT and 30 sera from 15 pregnancies with PB. Two sera were sampled from each pregnant woman: one in the first trimester and another one in the second trimester. Early pregnancy IM concentration showed a direct correlation with gestational age: Neo (rho=0.262, P=0.004), Neo/Cre (rho=0.372, P<0.001), CRP (rho=0.187, P=0.041), and Chito (rho=0.039, P=0.66). The correlation was present in both categories of patients with BT and PB. Patients with PB before 34 week of pregnancy (wp) and 32 wp showed higher Neo and Neo/Cre concentration than BT patients. A significant association was found between the risk of PB before 34 wp, PB before 32 wp, and Neo concentration (PB <34 wp: odds ratio (OR) =5.13, P=0.035) (PB <32 wp: OR=8.2, P=0.020) and, respectively, Neo/Cre concentration (PB <34 wp: OR=5.29, P=0.015) (PB <32 wp: OR=9.25, P=0.006). No association between CRP or Chito and PB age was found. IM concentration correlates with the gestational age at the time of blood sampling. Increased Neo and Neo/Cre concentration are associated with PB. Further studies are needed to evaluate the usefulness of these markers in clinical practice.

Melanin Quantification by Chemical Methods in Healthy and Melanoma Cell Lines Correlated with the Importance in the Development of Melanoma

In the last decade, the incidence of skin cancer has increased significantly and there is data that rank it as the most common form of malignancy in humans. Among the classified skin cancers, melanoma is the most severe with a significant mortality rate. The determining factor in the occurrence of skin cancer is generally recognised to be ultraviolet radiation. Skin pigmentation has been shown to provide a high degree of protection and this is due to melanin. In order to be able to consider certain hypotheses and to develop new approaches to melanoma, in this study it was studied the melanin content in certain cell types that have a direct connection with melanoma. The cell lines used in the study were: (i) human melanoma cell lines: A375, SK-MEL-1, SK-MEL-3, SK-MEL-5, SK-MEL-28, SH-4, and COLO 829; (ii) mouse melanoma cell lines: B164A5, B16F0, and B16F10; and (iii) healthy cell lines of human origin: HEMa (primary melanocytes), HaCaT (immortalised keratinocytes) and 1BR3 (human fibroblasts). The results obtained pointed out that A375, SK-MEL-28 and SK-MEL-5 cells do not produce melanin, SK-MEL-1, SH-4 and SK-MEL-3 cells produce melanin while COLO 829 cells � only in small passages produce melanin. Of the 3 lines of murine melanoma tested, the one that produces melanin in a higher concentration is B16F10, followed by B16F0 and B164A5.

Thrombospondin-1 Serum Levels In Hypertensive Patients With Endothelial Dysfunction After One Year Of Treatment With Perindopril

Background

Thrombospondin-1 (TSP-1) is a matricellular functional protein of the extracellular matrix. As it is not constitutively present extracellularly, its secretion is enhanced in several situations, namely injury, chronic pathology, tissue remodeling, angiogenesis, and aging. Over the last decade, TSP-1 has been reported to be involved in complex and opposing biological effects on vasculature in the context of NO signaling. Several studies have reported high patient TSP-1 plasma levels, indicating that the protein can potentially serve as a prognostic marker for pulmonary arterial hypertension.

Materials and methods

Here, we aimed to quantify TSP-1 serum levels in hypertensive patients with endothelial dysfunction before and after one year of treatment with Perindopril (an antihypertensive drug with vasoprotective properties).

Results

After one year of treatment, TSP-1 levels increased in hypertensive patients compared to baseline (T0: 8061.9 ± 3684.80 vs T1: 15380±5887 ng/mL, p<0.001) and compared to non-hypertensive controls (9221.03 ± 6510.21 ng/mL). In contrast, pentraxin-3 plasma levels were decreased after one year of Perindopril treatment in both hypertensive (T0: 0.91 ± 0.51 vs T1: 0.50 ± 0.24 ng/mL, p<0.001) and control group (1.36 ±1.5 ng/mL) patients, although flow-mediated vasodilation and intima-media thickness assessment parameters were not significantly changed. Systolic and diastolic blood pressure values as well as levels of fibrinogen, high-sensitivity C-reactive protein, triglycerides, and alanine aminotransferase were found to be significantly lower after one year of treatment with Perindopril. High levels of TSP-1 strongly correlated with platelet count (positive), lymphocytes (positive), red cell distribution width-CV (positive), systolic blood pressure (negative), and mean corpuscular hemoglobin (negative) after one year of treatment. Blood urea nitrogen was found to be a protective factor for TSP-1, while glucose and heart rate were found to be risk factors prior to and after treatment.

Melanin and Behaviour of Melanoma-related Cell Lines in the Presence of Ultraviolet B Type Radiation

Melanoma is a malignant disease of the cutaneous organ that shows significant aggression, resistance to treatment and increased mortality. Melanin and B-type ultraviolet radiation are key factors in the appearance and development of melanoma. In this study, the melanocyte and two melanoma tumor cells behaviour was evaluated in the presence of UVB radiation. The results highlighted the significant impairment of melanin-producing malignant cells, COLO-829, at both radiation doses tested.

Carpal tunnel release: transverse or longitudinal limited-incisions?

AIMS

Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy of the upper extremity. Surgical decompression through a limited open palmar incision is still the most widely used treatment. The aim of this study was to compare two different incision surgical techniques for carpal tunnel surgery.

PATIENTS AND METHODS

In this retrospective study, 41 patient hands (transverse surgery) were compared with 55 controls (longitudinal surgery) using, as validated outcome instruments, the "Boston Carpal Tunnel Questionnaire" for postoperative effectiveness to measure symptoms, disability and health-related quality of life. The patients were monitored just before the CTS surgery and then 4 weeks and 3 months after surgery.

RESULTS

Complications resulted few and comparable for both techniques. Results showed similar outcomes in both procedures regarding symptoms release and function, except for one month results where function was better for the transverse incision (p<0.01) which required reduced time, anyway.

CONCLUSIONS

The transverse incision technique proved a suitable optimal solution for carpal tunnel release. This technique, therefore, induces to a better tolerated scar at short term follow up, compared to a standard palmar longitudinal incision.

Breast reconstruction with autologous tissue--our clinical experience

INTRODUCTION

Breast reconstruction after mastectomy gained new grounds since the introduction of autologous tissue and oncoplastic surgery techniques. Nowadays large postoperative breast defects can be treated with high quality tissues obtained by autogenous flap surgery, to achieve the best functional and physical results.

OBJECTIVES

The purpose of this study is to analyze our results in breast reconstruction using autologous tissue and to emphasize the importance of a multidisciplinary team.

MATERIAL AND METHODS

During a five year period (2005-2009) we performed 28 breast reconstructions after cancer surgery, 15 in delayed and 13 in primary reconstruction, using three types of flaps: latissiumus dorsi flap, transverse rectus abdominis myocutaneous flap and deep inferior epigastric artery perforator flap.

RESULTS

Functional and cosmetic results were very good, only minor complications such as seroma and hematoma of the donor site and partial/marginal flap necrosis occurred after the surgical procedure. There were no major complications like total flap loss.

CONCLUSIONS

Breast reconstruction with autologous tissue is a safe, well proved, although not easy procedure that confers best functional and cosmetic results and is at the same time oncologically safe.