Pandemic Stressors and Adaptive Responses: A Longitudinal Analysis of the Quality of Life and Psychosocial Dynamics among Urothelial Cancer Patients

The 2019 coronavirus disease (COVID-19) pandemic has had a profound influence on different sectors of society, including health. This study hypothesized a significant impact of the pandemic on the quality of life and psychosocial well-being of urothelial cancer patients, specifically anticipating a decrease in anxiety and depression scores as the pandemic progressed. The primary objectives were to assess longitudinal changes in quality of life indexes, evaluate Healthcare Anxiety and Depression Scale (HADS) score trends over three years (2020-2022), and identify any correlational patterns between the progression of the pandemic and anxiety, depression, and stress levels among this cohort. A cross-sectional analysis was conducted on Eastern Cooperative Oncology Group (ECOG) 1 and Tumor Node Metastasis (TNM) stage 1 bladder cancer patients from the Timis County Emergency Clinical Hospital in Romania. Sixty patients were evaluated each year from 2020 to 2022, utilizing a detailed selection process involving the review of both the hospital database and paper records. Key data included demographic information, medical history, and responses to the Patient Health Questionnaire (PHQ-9), Short Form (SF-36), HADS, and Generalized Anxiety Disorder (GAD-7) questionnaires. A total of 163 completed questionnaires were analyzed, providing insight into various aspects of patients' experiences during the pandemic. Notably, the mean hospitalization days ranged from 3.6 ± 2.1 days in 2020 to 4.0 ± 2.4 days in 2022 (p = 0.663). Concerns that current symptoms might be pandemic-related spiked to 63.5% in 2021, but reduced to 50.9% in 2022, with this fluctuation being significant (p = 0.026). The perception of decreased quality of or accessibility to medical care was significant over the years, with a decline to 52.7% in 2022 (p = 0.033). Quality of life assessments demonstrated an upward trend, from an average score of 55.9 ± 8.9 in 2020 to 59.3 ± 8.8 in 2022 (p = 0.049). Interestingly, anxiety levels, as indicated by the HADS survey, revealed a significant decline from a score of 7.8 in 2020 to 6.5 in 2022 (p = 0.008). On the other hand, GAD-7 scores displayed a downward trend over the years, potentially indicative of developed coping strategies (p = 0.034). This study provides a comprehensive insight into the fluctuating dynamics of psychosocial factors and quality of life among urothelial cancer patients during the pandemic years. It underscores a potential adaptive response, as evidenced by the decrease in anxiety levels and an upward trend in the quality of life scores over the period. These findings highlight the resilience and adaptability of this patient cohort amidst the challenges posed by the pandemic, potentially guiding future interventions and supports in similar health crises.

Contemporary Biomarkers for Renal Transplantation: A Narrative Overview

Renal transplantation (RT) is the preferred treatment for end-stage renal disease. However, clinical challenges persist, i.e., early detection of graft dysfunction, timely identification of rejection episodes, personalization of immunosuppressive therapy, and prediction of long-term graft survival. Biomarkers have emerged as valuable tools to address these challenges and revolutionize RT patient care. Our review synthesizes the existing scientific literature to highlight promising biomarkers, their biological characteristics, and their potential roles in enhancing clinical decision-making and patient outcomes. Emerging non-invasive biomarkers seemingly provide valuable insights into the immunopathology of nephron injury and allograft rejection. Moreover, we analyzed biomarkers with intra-nephron specificities, i.e., glomerular vs. tubular (proximal vs. distal), which can localize an injury in different nephron areas. Additionally, this paper provides a comprehensive analysis of the potential clinical applications of biomarkers in the prediction, detection, differential diagnosis and assessment of post-RT non-surgical allograft complications. Lastly, we focus on the pursuit of immune tolerance biomarkers, which aims to reclassify transplant recipients based on immune risk thresholds, guide personalized immunosuppression strategies, and ultimately identify patients for whom immunosuppression may safely be reduced. Further research, validation, standardization, and prospective studies are necessary to fully harness the clinical utility of RT biomarkers and guide the development of targeted therapies.

Potential Diagnostic Biomarker Detection for Prostate Cancer Using Untargeted and Targeted Metabolomic Profiling

Prostate cancer (PCa) remains one of the leading causes of cancer mortality in men worldwide, currently lacking specific, early detection and staging biomarkers. In this regard, modern research focuses efforts on the discovery of novel molecules that could represent potential future non-invasive biomarkers for the diagnosis of PCa, as well as therapeutic targets. Mounting evidence shows that cancer cells express an altered metabolism in their early stages, making metabolomics a promising tool for the discovery of altered pathways and potential biomarker molecules. In this study, we first performed untargeted metabolomic profiling on 48 PCa plasma samples and 23 healthy controls using ultra-high-performance liquid chromatography coupled with electrospray ionization quadrupole time-of-flight mass spectrometry (UHPLC-QTOF-[ESI+]-MS) for the discovery of metabolites with altered profiles. Secondly, we selected five molecules (L-proline, L-tryptophan, acetylcarnitine, lysophosphatidylcholine C18:2 and spermine) for the downstream targeted metabolomics and found out that all the molecules, regardless of the PCa stage, were decreased in the PCa plasma samples when compared to the controls, making them potential biomarkers for PCa detection. Moreover, spermine, acetylcarnitine and L-tryptophan had very high diagnostic accuracy, with AUC values of 0.992, 0.923 and 0.981, respectively. Consistent with other literature findings, these altered metabolites could represent future specific and non-invasive candidate biomarkers for PCa detection, which opens novel horizons in the field of metabolomics.

Rats, Neuregulins and Radical Prostatectomy: A Conceptual Overview

In the contemporary era of early detection, with mostly curative initial treatment for prostate cancer (PC), mortality rates have significantly diminished. In addition, mean age at initial PC diagnosis has decreased. Despite technical advancements, the probability of erectile function (EF) recovery post radical prostatectomy (RP) has not significantly changed throughout the last decade. Due to virtually unavoidable intraoperative cavernous nerve (CN) lesions and operations with younger patients, post-RP erectile dysfunction (ED) has now begun affecting these younger patients. To address this pervasive limitation, a plethora of CN lesion animal model investigations have analyzed the use of systemic/local treatments for EF recovery post-RP. Most promisingly, neuregulins (NRGs) have demonstrated neurotrophic effects in both neurodegenerative disease and peripheral nerve injury models. Recently, glial growth factor 2 (GGF2) has demonstrated far superior, dose-dependent, neuroprotective/restorative effects in the CN injury rat model, as compared to previous therapeutic counterparts. Although potentially impactful, these initial findings remain limited and under-investigated. In an effort to aid clinicians, our paper reviews post-RP ED pathogenesis and currently available therapeutic tools. To stimulate further experimentation, a standardized preparation protocol and in-depth analysis of applications for the CN injury rat model is provided. Lastly, we report on NRGs, such as GGF2, and their potentially revolutionary clinical applications, in hopes of identifying relevant future research directions.

The influence of the Covid-19 pandemic on the 90-day mortality rate after emergency surgery for colon cancer

The Covid-19 pandemic had a significant impact on the treatment of colon cancer. This was due to the redistribution of doctors and medical resources to empower the treatment of Sars-CoV-2-infected patients. Moreover, the restrictions imposed by the authorities on the general population and hospitals were other key elements that had to be taken into consideration. The surgical activity was massively reduced for both elective and emergency surgeries during the pandemic; initially, the elective ones were postponed. This study aimed to analyze the impact of the Covid-19 pandemic on the 90-day postoperative mortality rate of patients who underwent emergency surgery for colon cancer in the First General Surgery Clinic of Pius Brinzeu County Hospital Timisoara. For conducting this study, data from patients who underwent emergency surgery for colon cancer between 26.02.2020-01.10.2021 and the same period of 2016-2017 and 2018-2019 were collected and analyzed, with a p<0.05 being considered statistically significant. As a result, the 90-days postoperative mortality rate increased to 34.5% during the pandemic. A 22.55% rate was observed during 2016-2017 and an 18.4% rate in 2018-2019. In addition, during the pandemic, correlations w ere identified between the presence of 90-day postoperative mortality and severe symptomatology when presenting to the hospital, stage of the disease, and Charlson comorbidity index. All these aspects influenced the 90-days mortality rate of patients undergoing emergency surgery to treat colon cancer during the pandemic.

Impact of Covid-19 pandemic on a general surgery clinic

The Covid-19 pandemic has had a massive impact on global health, social and economic well-being worldwide. In addition to the direct effects of the disease on patients infected with the virus, this pandemic has severely affected the activity of surgical clinics around the world. One of the significant issues was an important decrease in the number of surgeries performed even in countries with highly performant medical systems. This study aimed to analyze the effects of the pandemic on the 1^st General Surgery Clinic in Timisoara County Hospital, compared to 2018-2019. In order to conduct this study, data regarding the activity of the clinic in the pandemic period and 2018-2019 was collected and analyzed from a statistical point of view, considering a p<0.05 as statistically significant. There were significant differences between the 2 periods regarding the number of hospitalized patients, the number of patients undergoing elective or emergency surgery, and the total number of surgeries performed. Due to the restrictions imposed, there was an increase in the average monthly mortality rate and a decrease in the average length of hospital stay. Covid-19 pandemic led to a severe activity restriction of the surgery clinics due to the restrictions imposed by the authorities and the reorganization of the clinics to comply with the epidemiological requirements. Also, the limitation of patients' access to surgical treatment and their fear of coming in contact with the hospital environment led to their presentation in more advanced stages of the disease, with more severe symptoms and a higher mortality rate during the pandemic.

The consequences of the Covid-19 pandemic on elective surgery for colon cancer

AIM OF THE STUDY

This study presents the impact of the Covid-19 pandemic on elective surgical treatment of patients diagnosed with colon cancer, in a University Clinic of Surgery.

MATERIAL AND METHODS

The data from patients who underwent an elective surgery procedure for colon cancer during the pandemic period (26.02.2020-01.10.2021) was analyzed. This period was compared with the same interval for the years 2016-2017 and 2018-2019.

RESULTS

There was a significant decrease in the number of patients that underwent an elective surgery for colon cancer during the pandemic. The Covid-19 generated pandemic has influenced the number of days from diagnosis to treatment, preoperative and postoperative hospitalization. There was an increase in the number of patients with severe symptoms, with complete or incomplete ileus. The number of lymphatic nodes harvested increased during the last period of study, being correlated with the advanced cancer stage.

CONCLUSIONS

The Covid-19 pandemic had an influence on the management of the patients with colon cancer undergoing an elective surgery procedure. Firstly, their number decreased compared to the other periods, and they presented more severe symptoms. The duration of the surgical act was extended, but the postoperative stay was shortened.

KEY WORDS

Colon cancer, Covid-19 Pandemic, Duration of surgery, Elective surgery.

Long Noncoding RNA NEAT1 as a Potential Candidate Biomarker for Prostate Cancer

Background: Prostate cancer (PCa) remains one of the leading causes of cancer-related mortality in men worldwide, mainly due to unsatisfactory diagnostic methods used at present, which lead to overdiagnosis, unnecessary biopsies and treatment, or misdiagnosis in early asymptomatic stages. New diagnostic biomarkers are needed for a correct and early diagnosis. Long noncoding RNAs (lncRNAs) have been broadly studied for their involvement in PCa biology, as well as for their potential role as diagnostic biomarkers. Methods: We conducted lncRNA profiling in plasma and microdissected formalin-fixed paraffin-embedded (FFPE) tissues of PCa patients and attempted validation for commonly dysregulated individual lncRNAs. Results: Plasma profiling revealed eight dysregulated lncRNAs, while microarray analysis revealed 717 significantly dysregulated lncRNAs, out of which only nuclear-enriched abundant transcript 1 (NEAT1) was commonly upregulated in plasma samples and FFPE tissues. NEAT1’s individual validation revealed statistically significant upregulation (FC = 2.101, p = 0.009). Receiver operating characteristic (ROC) analysis showed an area under the curve (AUC) value of 0.7298 for NEAT1 (95% CI = 0.5812–0.8785), suggesting a relatively high diagnostic value, thus having a potential biomarker role for this malignancy. Conclusions: We present herein data suggesting that NEAT1 could serve as a diagnostic biomarker for PCa. Additional studies of larger cohorts are needed to confirm our findings, as well as the oncogenic mechanism of NEAT1 in the development of PCa.

Analysis of Tumor Depth Invasion With Anti-Smoothelin Antibody in Equivocal Transurethral Resection of Urinary Bladder Tumor Surgical Specimens

OBJECTIVE

To examine the expression and value of the smoothelin marker in control cases, to standardize the working method, and to analyze its application in pathologic staging process of problematic transurethral resection of bladder tumor (TURBT) cases.

MATERIAL AND METHODS

Immunohistochemical (IHC) staining was performed on tumor-free bladder wall sections, tumor-free large bowel sections, TURBTs with unequivocal tumor stage, and TURBTs with equivocal stage. The IHC staining of muscularis mucosa (MM), muscularis propria (MP), and blood vessels was evaluated semiquantitatively.

RESULTS

Smoothelin IHC staining pattern ranged from negative (30% to 67% cases) to 2+ (0% to 15% cases) in MM and from 1+ (10% to 50% cases) to 3+ (9% to 48% cases) in MP. When compared on the same slide, the smoothelin expression of MP showed a stronger staining intensity than the one of the MM in all the analyzed cases. Blood vessel muscle cells stained in a constant intensity as the MM (r = 0.9808; r = 0.9604). Smoothelin determined restaging of 33% of the problematic TURBT cases.

CONCLUSION

Smoothelin is an IHC marker that shows differential staining between coexistent MM and MP; however, variations in staining intensity and pattern may occur, aspects that can be influenced by different technique variables. We recommend using this marker as a diagnostic tool in problematic TURBT cases only when there is sufficient experience in control cases with this antibody.

The Association Between Resistivity Index (IR) and the sFlt-1 and PIGF Values in Pregnant Women With Risk of Preeclampsia

Worldwide, 5-8% of pregnant women are diagnosed with preeclampsia. This disease increases the morbidity and mortality of the fetus and pregnant woman, especially in developing countries. Preeclampsia is characterized by systolic blood pressure ] 140mmHg or diastolic blood pressure] 90mmHg as measured twice, and 24 h proteinuria �0.3 g, after 20 weeks of gestation. The cause of preeclampsia is still incompletely elucidated. Numerous studies have suggested to modernize the definition of preeclampsia by incorporating key biomarkers of either placental or vascular origins, including placental growth factor (PIGF) and antiangiogenic factors such as tyrosine kinase-1 (sFlt-1) in the diagnosis of preeclampsia and the risk of occurrence of the disease in the second trimester of pregnancy [1-5]. We studied a group of 50 patients with a 21-week pregnancy diagnosis, we calculated the ratio between sFlt-1 and PIGF and we tested to see if there was an association between this ratio and the resistivity index (IR) of the uterine artery using the artery Doppler ultrasound. The PIGF level in our group was decreased in women who developed preeclampsia compared to the control group where this problem did not occur. Doppler ultrasound examination during the second trimester of pregnancy may provide extra data for prediction of preeclampsia. Although much of pathophysiology of preeclampsia has been explained, the exact etiology of this disorder remains unclear. It is certain that before the clinical signs of preeclampsia are detectable, there is an imbalance between pro-angiogenic and anti-angiogenic factors.

Can be Considered the CA-125 and Neutrophil-to-lymphocyte Ratio Values as a Diagnostic Value in Ovarian Endometriosis?

In Romania it is estimated that there are half a million patients with endometriosis. The main symptoms are pain (70% of patients with chronic pelvic pain have endometriosis) and infertility (50% of infertile patients have endometriosis). It is difficult to make an accurate diagnosis. Numerous studies show a 7-10-year delay in diagnosis in women in developing countries. 47% of patients should be seen by more than 5 physicians over time until the diagnosis is established. The treatment for endometriosis is the surgical procedure and it is most often performed laparoscopically. The present study was carried in the Obstetrics and Gynecology Departments of the Pius Brinzeu Emergency Clinical Hospital Timisoara. We have included in this study patients who were hospitalized between 2013 and 2017. We have 142 patients who qualified for this study. All the patients had made the same medical tests: we collected information about their age, the neutrophil, lymphocyte and CA125 values, the position of the cyst and the cyst dimension. The aim of this study is to find if there is any association between the CA-125 markers (coelomic epithelial antigen) and the neutrophil-to-lymphocyte ratio in patients who were diagnosed with ovarian endometriosis by transvaginal ultrasound. In all cases the patients underwent laparoscopic surgery. After performing a correlation and regression analysis we obtained that we have a positive strong significant association between the CA 125 values and the ratio values (r=0.94; R2=0.88; p[0.001) . After the surgical excision of endometriosis, CA-125 can be used to monitor the evolution of endometriosis outbreaks, especially when there is a recurring severe pain.

Are night-time voiding and lower urinary tract symptoms significant risk factors for hip fractures caused by falling during the night in male subjects?

OBJECTIVES

The aim of our study was to assess the incidence of night-time voiding in a population of male patients with hip fracture, and to analyze the correlations between the severity of the lower urinary symptoms and the other most significant comorbidities of the patients.

PATIENTS AND METHODS

We have initially selected a group of patients containing all males admitted into a Department of Orthopedic Surgery with the diagnosis of hip fracture, with indication for replacement surgery, over a four-year period. Applying well-defined inclusion and exclusion criteria, we have selected all the patients who have reported that falling during the night, on the way to the toilet (for micturition), was the event leading to the hip fracture. A comprehensive medical history and the International Prostate Symptom Score (IPSS) Questionnaire were gathered from all the patients and the obtained data were analyzed.

RESULTS

From a total of 363 patients with hip fractures, 68 cases were attributable to night-time voiding. The detailed analysis of the 68 patients has shown that all of them had significant nocturia (2.72 episodes of voiding per night, in average), but only 11 of them were already diagnosed with lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). Moreover, only four of the eleven patients diagnosed with BPH were taking specific therapy at the moment of their falling leading to hip fracture. Subsequent analysis has shown that a group of 45 patients with no previously known co-morbidities, had similar IPSS score results with the total group of 68 patients.

CONCLUSIONS

Night-time voiding and LUTS are underdiagnosed in the general male population, as they represent significant risk factors for hip fractures due to falling during the night. The low level of BPH/LUTS therapy adherence adds a supplementary risk for falling during the night.

Considerations on Thermal Behaviour and Porosity of Renal Calculi in Bisphosphonate -Treated Postmenopausal Women

A longitudinal, randomized, five year follow-up clinical and experimental study was conducted during May 1, 2011 - June 30, 2016. A number of 125 eligible postmenopausal women (BMD T-score spine (-2.8 � 0.5)); BMD at the femoral hip (-2.6 � 0.8), treated only with biphosphonates, were enrolled in the study. The patient�s age ranged between 60 and 65 years. All the women were stone formers, with more than five episodes of crystalluria in the last five years. Exclusion criteria: kidney chronic diseases, use of drugs known to affect bone metabolism and renal function, patients with multi-morbidities. The aim of our study was to assess the connection between postmenopausal osteoporosis and the risk of worsening calcium balance in urolithiasis, based on the complex thermogravimetric findings and porosity studies of renal stones eliminated by these patients. The study of renal-urinary concretions offers the possibility to amplify the specific effects of the thermal decomposition processes of substances, reflecting the sample�s global composition. The research of calculi porosity gives information about the dissolution possibilities of the renal-urinary concretions. In conclusion, in postmenopausal women, proper administration of bisphosphonate therapy must accompany the supplementary medication with calcium and vitamin D, always correlated to the metabolic status of the osteoporotic patient.

The role of prostatic inflammation biomarkers in the diagnosis of prostate diseases

Benign prostatic hyperplasia (BPH) and prostate cancer (PCa) are chronic conditions, which are hormone-dependent and epidemiologically associated with prostate inflammation. As a large number of studies have demonstrated, the stimulation of T-cells at the level of prostatic chronic inflammatory infiltrates is followed by stromal and epithelial cell proliferation. The aim of this review is to present the actual level of knowledge in the field of prostatic immune response and chronic inflammation, and to analyze the relationships between chronic inflammation and BPH/PCa. The most studied prostatic inflammation biomarkers detected in biological fluids are also presented, together with their potential roles in the diagnosis and prognosis of prostatic disease.

Retinoic acid receptor β2 (RARβ2): nonivasive biomarker for distinguishing malignant versus benign prostate lesions from bodily fluids

Alterations in the methylation patterns of promoter CpG islands have been associated with the transcriptional inhibition of genes in many human cancers, including prostate cancer (PCa).

OBJECTIVES

The aim of our study was to evaluate the diagnostic value of aberrant promoter hypermethylation of retinoic acid receptor β2 (RARβ2) gene in serum DNA samples from patients with the diagnosis of PCa and benign prostatic hyperplasia (BPH), as a new epigenetic biomarker in distinguishing between malignant and non-malignant lesions.

MATERIALS AND METHODS

Aberrant promoter hypermethylation was investigated in genomic DNA isolated from the serum of 91 patients diagnosed with of PCa and 94 with BPH (control subjects). In order to evaluate the methylation status of the RARβ2 gene we used the quantitative methylation-specific PCR (QMSP) method.

RESULTS

Promoter hypermethylation of RARβ2 gene was detected in serum samples from 89 of 91 (92.86%) patients with PCa, and in 10 of the 94 (10.7%) patients with BPH.

CONCLUSIONS

RARβ2 represents a promising molecular biomarker which may be used in discriminating between malignant and benign prostatic diseases by noninvasive methods.

Bipolar vaporization of the prostate: is it ready for the primetime?

Although transurethral resection of the prostate is still the 'gold standard' in the surgical management of benign prostatic hyperplasia, it is associated with significant morbidity. This review presents one of its most successful alternatives, bipolar transurethral vaporization of the prostate, a procedure that has emerged during the last decade. The technical principles are presented, together with the trials that compare it with the standard resection technique. The review concludes that bipolar vaporization of the prostate is safe and effective, providing very good hemostasis control and low complication rates, at a significantly reduced cost per procedure. Improved vision and hemostasis make it suitable for patients with cardiac pacemakers, bleeding disorders, or those under anticoagulant therapy. However, long-term follow-up and more randomized trials are still needed, to validate the value of bipolar vaporization.