High Plasma Angiopoietin-2 Levels Predict the Need to Initiate Dialysis within Two Years in Patients with Chronic Kidney Disease.

Volume status, congestion, endothelial activation, and injury all play roles in glomerular filtration rate (GFR) decline. In this study, we aimed to determine whether the plasma endothelial and overhydration markers could serve as independent predictors for dialysis initiation in patients with chronic kidney disease (CKD) 3b-5 (GFR < 45 mL/min/1.72 m2) and preserved ejection fraction. A prospective, observational study in a single academic center was conducted from March 2019 to March 2022. Plasma levels of angiopoietin (Ang)-2, Vascular Endothelial Growth Factor-C (VEGF-C), Vascular Cell Adhesion Molecule-1 (VCAM-1), Copeptin (CPP), beta-trace protein (BTP), brain natriuretic peptide (BNP), and cardiac troponin I (cTnI) were all measured. Lung ultrasound (US) B-lines, bioimpedance, and echocardiography with global longitudinal strain (GLS) were recorded. The study outcome was the initiation of chronic dialysis (renal replacement therapy) during 24 months of follow-up. A total of 105 consecutive patients with a mean eGFR of 21.3 mL/min/1.73 m were recruited and finally analyzed. A positive correlation between Ang-2 and VCAM-1 and BTP was observed. Ang-2 correlated positively with BNP, cTnI, sCr, E/e', and the extracellular water (ECW)/intracellular water (ICW) ratio (ECW/ICW). After 24 months, a deterioration in renal function was observed in 47 patients (58%). In multivariate regression analysis, both VCAM-1 and Ang-2 showed independent influences on risk of renal replacement therapy initiation. In a Kaplan-Meier analysis, 72% of patients with Ang-2 concentrations below the median (3.15 ng/mL) survived without dialysis for two years. Such an impact was not observed for GFR, VCAM, CCP, VEGF-C, or BTP. Endothelial activation, quantified by plasma levels of Ang-2, may play a key role in GFR decline and the need for dialysis initiation in patients with CKD 3b, 4, and 5.

Haemoglobin and C-reactive protein levels are efficient at identifying neoplasms as the most common early mortality of chronic diseases in emergency department patients.

Introduction: Extensive research has focused on emergency department (ED) and post-admission deaths, seeking to understand their frequency and causative factors. With the rising prevalence of advanced diseases, it is crucial to identify patients in need of end-of-life care and ensure its high quality. In this epidemiological study, we analyse routine ED blood tests to identify early warning signs of deteriorating patients with common non-traumatic and non-infectious (chronic) conditions. Material and methods: We conducted a retrospective single-centre study for the years 2016-2019 using medical records and electronic data from the Multi-Specialistic Hospital in Gorzów Wielkopolski, Poland. We examined 8971 unique patients with circulatory, neoplastic, and endocrine diseases. We assessed the impact of 2 grouping variables (survivors and non-survivors) on a continuous outcome variable, including age and 37 routine blood tests. Results: Two-way analysis of variance revealed that haemoglobin (Hb), haematocrit (Hct), and C-reactive protein (CRP) are the best differentiating biomarkers for early death in ED patients with cardiovascular, oncological, and endocrine diseases (excluding Hct due to its strong correlation with Hb). The Marczewski-Steinhaus taxonomy highlighted that oncological patients had the shortest survival time, averaging just 2 days from admission among ED non-survivors. Conclusions: Among routinely tested ED biomarkers, Hb and CRP levels are efficient at identifying neoplasms as the most common early mortality of chronic diseases in ED patients.

Microbiological effects in patients with leg ulcers and diabetic foot treated with Lucilia sericata larvae.

Lucilia sericata bottle fly worms can be used to heal infected, chronic, or necrotic wounds, including those associated with ulceration and diabetic foot. The study aimed to evaluate changes in the microflora in patients treated with L sericata larvae due to leg ulcers and diabetic foot. One hundred twenty-nine patients diagnosed with lower limb ulceration and diabetic foot were enrolled in the study, of which 80 of them met the eligibility criteria for maggot debridement therapy (MDT). On the contrary, 49 unqualified patients were offered ozone therapy (22 with leg ulcers; 27 with diabetic foot). In each of these patients, a microbiological swab was performed before and after the start of therapy. The group of 80 patients was further divided into four equal groups in terms of the treated area (lower leg vs foot) and the number of larvae/cm2 (5 vs 10). Twenty-three particular species of bacteria in the infected wound were studied microbiologically in terms of presence/absence within the wound environment before and after treatment of patients with diabetic foot and lower limb ulceration. It was noted that there was a more intensive bacterial accumulation in the feet of patients compared to legs; furthermore, this applies to almost all analysed species. Diabetes status is also a clinical factor that generates a lower chance of bacterial appearance in the wound environment. Densification of MDT larvae per wound area unit also reduced the chance of the presence of Corynebacterium species, Enterobacteriaceae, Pseudomonas aeruginosa, Staphylococcus aureus MSSA, and Streptococcus coagulase negativa; however, it increased the likelihood of occurrence for Proteus mirabilis and the Proteus species. A microbiological analysis in this non-reference study shows the efficacy of larval therapy for leg and foot ulcers. Rearrangement of the microflora within the wound has been reported as a result of the therapy.

Delaying BCG immunotherapy onset after transurethral resection of non-muscle-invasive bladder cancer is associated with adverse survival outcomes.

PURPOSE: This study was carried out to assess whether a prolonged time between primary transurethral resection of non-muscle-invasive bladder cancer (TURB) and implementation of bacillus Calmette-Guerin (BCG) immunotherapy (time to BCG; TTBCG) is associated with adverse oncological survival in patients with T1 high-grade (HG) non-muscle-invasive bladder cancer (NMIBC). MATERIALS AND METHODS: Data on 429 patients from 13 tertiary care centers with primary T1HG NMIBC treated with reTURB and maintenance BCG between 2001 and 2019 were retrospectively reviewed. Change-point regression was applied following Muggeo's approach. The population was divided into subgroups according to TTBCG, whereas the recurrence-free survival (RFS) and progression-free survival (PFS) were estimated with log-rank tests. Additionally, Cox regression analyses were performed. Due to differences in baseline patient characteristics, propensity-score-matched analysis (PSM) and inverse-probability weighting (IPW) were implemented. RESULTS: The median TTBCG was 95 days (interquartile range (IQR): 71-127). The change-point regression analysis revealed a gradually increasing risk of recurrence with growing TTBCG. The risk of tumor progression gradually increased until a TTBCG of approximately 18 weeks. When the study population was divided into two subgroups (time intervals: ≤ 101 and > 101 days), statistically significant differences were found for both RFS (p = 0.029) and PFS (p = 0.005). Furthermore, in patients with a viable tumor at reTURB, there were no differences in RFS and PFS. After both PSM and IPW, statistically significant differences were found for both RFS and PFS, with worse results for longer TTBCG. CONCLUSION: This study shows that delaying BCG immunotherapy after TURB of T1HG NMIBC is associated with an increased risk of tumor recurrence and progression.

Analysis of age influence on oncological results and toxicity of BCG immunotherapy in non-muscle invasive bladder cancer.

PURPOSE: The aim of this study was to analyse the influence of age on the treatment outcome and toxicity in patients with T1HG non-muscle invasive bladder cancers treated with BCG immunotherapy. METHODS: Data from 637 patients with primary T1HG bladder cancer who were treated between 1986 and 2016 in two academic centres were retrospectively reviewed. Median follow-up was 57 months. Patients were divided into two groups: younger (< 70 years old) and older (≥ 70 years old). Additional analyses in subgroups of older (> 75 and > 80) patients were performed. Log-rank test, Cox regression analysis, and propensity score matching were performed to compare the groups. RESULTS: There were 389 patients below and 248 patients above or equal 70 years old. Recurrence-free, progression-free, and cancer-specific survival rates did not differ significantly between younger and older patients. Recurrence-free survival for younger and older patients were 55.4% vs 52.9%, progression-free survival 75.9% vs 76.6%, and cancer-specific survival were 87.5% vs 89.9% (all p > 0.05). Differences in the oldest subgroups also did not reach statistical significance. In both regression analysis and propensity score matching, no statistically significant associations of age with any of analysed end-points were found. Finally, there were no statistically significant differences between younger and older group in terms of moderate and severe complications occurrence (47.6% vs. 44.5%; p > 0.05) CONCLUSIONS: It was shown that increasing age was not associated with BCG immunotherapy oncological outcomes, or with BCG toxicity in T1HG non-muscle invasive bladder cancer.

Analysis of Serum Markers with Regard to Treatment Procedures in Advanced Stage Prostate Cancer Patients.

BACKGROUND Biomarkers predicting the efficacy of treatment for locally limited prostate cancer are greatly needed. This knowledge could improve the classification of patients for different methods of treatment and enable better recognition of groups with higher risk of biological recurrence. We prospectively assessed serial blood levels of apoptotic biomarkers and correlated them with response to treatment and clinical factors. MATERIAL AND METHODS Blood was collected from 25 patients with prostate cancer before and after surgery, 16 healthy volunteers with benign prostatic hyperplasia (BPH), and 14 patients with metastasized disease. Immunoenzymatic methods were used to determine circulating apoptotic and inflammatory mediators, including tumor necrosis factor alpha (TNF-alpha), type I receptor (TNFRI), and type II receptor (TNFRII); FAS ligand (FasL); TNF-related apoptosis-inducing ligand (TRIAL); caspase 8 (Cas8); caspase 9 (Cas9); DNA methylation (metDNA); P-selectin; and high-sensitivity C-reactive protein. The total circulating fragments of cell-free DNA (cfDNA) were measured directly in serum. RESULTS Peripheral serum prostate-specific antigen increased rapidly together with cfDNA. A negative correlation was noted between tumor volume and TNFRI and TNFRII. Postsurgery P-selectin level was decreased, and metDNA and TNFRII levels were increased. Three comparisons were made between patient groups: surgical vs. BPH; surgical vs. palliative; and palliative vs. BPH. TNFRI, TNFRII, metDNA, P-selectin, Cas8, and FasL were shown to have significant roles. CONCLUSIONS The study indicated significant roles for cfDNA, both TNF receptors, metDNA, and P-selectin as serum biomarkers in patients with prostate cancer.

Polymorphisms of genes encoding cytokines predict the risk of high-grade bladder cancer and outcomes of BCG immunotherapy.

INTRODUCTION: The present study investigated the association of cytokines genes polymorphisms (IL-2, IL-8 and IL-18) and polymorphisms in genes encoding molecules related to the differentiation of Th17 subpopulation (IL-17 and IL-23R) with the risk of bladder cancer (BC) and response to BCG immunotherapy. MATERIAL AND METHODS: Altogether, 175 BC patients treated with BCG due to high-grade non-muscle invasive tumors and 207 healthy individuals were genotyped for the following polymorphisms: IL-17A-197G>A (rs2275913); IL-17F+7488T>C (rs763780); IL-23Rc.309C>A (rs10889677);IL-23Rc.1142G>A (rs11209026); IL-2-330T>G (rs2069762), IL-8-251A>T (rs4073), and IL-18-137G>C (rs187238) using the TaqMan SNP genotyping assays. RESULTS: The IL-23Rc.-309C>A[A] allele was associated with the risk of BC (OR: 1.42, p = 0.03). Moreover, heterozygocities for IL-17A-197G>A[GA] and IL-18-137G>C[GC] increased the risk of BC, as compared to both homozygotes (OR: 1.67, p = 0.01 and OR: 1.84, p = 0.008, respectively). The IL-18-137G>C[GC] heterozygous patients had the highest risk of tumor recurrence and progression, and the worst recurrence-free and progression-free survival. Homozygous IL-17A-197G>A[GG] patients presented the best recurrence-free survival, while IL-17A-197G>A[AA] patients had 1.8-fold higher risk of recurrence. CONCLUSIONS: The present study highlighted the importance of IL-17, IL-18, and IL-23R gene polymorphisms for BC susceptibility and BCG immunotherapy outcomes. It may help to identify appropriate candidates for early radical treatment.

The Optimal Timing of Restaging Resection before Introduction of Bacillus Calmette-Guerin Immunotherapy in Patients with High-Risk Non-Muscle-Invasive Bladder Cancer.

INTRODUCTION: The study aimed to analyze the influence of restaging transurethral resection of bladder tumor (reTURB) timing on outcomes in patients receiving Bacillus Calmette-Guerin (BCG) immunotherapy. MATERIAL AND METHODS: This retrospective study enrolled 491 patients with bladder cancer receiving BCG intravesical therapy between 1998 and 2016. All patients were followed up for at least 12 months and received at least 7 BCG instillations. The patients were analyzed in terms of recurrence free, progression free, and cancer specific survival (CSS). RESULTS: Median follow-up was 57 months (12-257 months). The risk for all analyzed clinical events was higher in patients who underwent reTURB after 6 weeks from primary TURB. After the change point of 57 days after primary resection, further delay was not associated with increased risk of recurrence and progression. The time limit for CSS was 76 days. With every 1 more day of time interval between TURB and reTURB, the risk of each clinical event in follow-up increased by 4%. CONCLUSIONS: There is no benefit of the reTURB performed after 8 weeks from primary TURB. Optimal timing of reTURB is from 2 to 6 weeks after initial TURB. However, even within this time frame, the sooner the procedure is performed, the risk of recurrence, progression, or cancer-specific death is lower.

[Heart failure in opole voivodeship - epidemiology and future perspectives].

Heart failure appears in 2% of the adult population in Europe. One in five people aged 40 years will develop heart failure during their lifetime. Heart failure touch 20,000 people in the Opole province. Heart failure is the second, after acute coronary syndromes, urgent cause of admissions to the Clinic of Cardiology at the University Hospital in Opole. The paper presents the prognosis of hospitalization of patients with heart failure for the years 2015-2050 taking into account the processes of depopulation taking place in our region. The analysis makes it possible to predict that the age group particularly exposed to heart failure in the coming decades will be people who today belong to teenagers and young adults. The article presents current methods of treatment of heart failure. Improvement in the prognosis of patients with heart failure can occur through the implementation of the guidelines for treatment of heart failure recommended by the ESC. This goal is to be achieved by introducing the "Comprehensive care for patients with heart failure (KONS)" program in our country. The shift of the burden of care for patient with heart failure to outpatient unit will result in a significant reduction in the number of hospitalizations.

Appraisal of Basic-Hemostatic Markers in Lung Cancer Patients During Follow-Up Care After Radiotherapy Treatment.

BACKGROUND The aim of this paper was to investigate the association between clinicopathological factors and the coagulation test in lung cancer patients during follow-up care after treatment. MATERIAL AND METHODS Ninety-five medical patients with histologically proven advanced lung carcinoma (LC) who had undergone radiotherapy were prospectively reviewed between January 2014 and December 2016. The study investigated the relationship between the biochemical results, the disease stage, and the survival rate in lung cancer patients. Post-treatment coagulation-based D-dimer (DD), fibrinogen (Fib), and complete blood count (CBC) were evaluated during the follow-up over a period of 2 years after treatment or until the patient's death. RESULTS An increase of D-dimer generates an increased chance of early death by approximately 0.03% per 1 D-dimer unit. In cases when the difference in the D-dimer concentration equals 1000, the risk of an early death increases by (1.00031000-1)×100%=35%. CONCLUSIONS High levels of D-dimer are associated with an advanced form of disease with metastasis and higher risk of early death in lung cancer patients.

Influence of Transurethral Resection of Bladder Cancer on Sexual Function, Anxiety, and Depression.

The standard of care in non-muscle invasive bladder cancer consists of transurethral tumor resection. The aim of this study was to evaluate the influence of transurethral resection of bladder tumor (TURB) on the patients' self-reported depression, anxiety, sexual satisfaction, and erectile dysfunction. Psychological condition of 252 male patients who underwent TURB was prospectively evaluated. The Hospital Anxiety and Depression Scale (HADS), simplified International Index of Erectile Function (IIEF-5), and Sexual Satisfaction Questionnaires (SSQ) were administered to patients before and 10 days after tumor resection. We found that primary anxiety, depression, and erectile dysfunction were all worse in cancer patients than those in the general population, and all further worsened after tumor resection. The post-resection worsening was influenced by the operation and catheterization time, complications, and the tumor characteristics. Taxonomical analysis shows that the greatest risk of depression aggravation concerned patients who were younger, had a higher body mass index, and a medium-sized tumor. We conclude that transurethral resection of non-muscle invasive bladder cancer may adversely affect sexual function, anxiety, and depression. Patients should be informed about potential complications to prevent the abandonment of a follow-up. The findings of this study stress the role of personalized medicine pursued by a multidisciplinary medical team.

[CyberKnife for prostate cancer patients. Update of 200 patients treatment results].

Introduction: This is an update regarding the treatment results of 200 prostate cancer patients' (PCP) CyberKnife based radioablation (the first group in Poland). The purpose of this study is reevaluation (after 2 years) of this treatment modality results of low (LR) and intermediate risk (IR) (including T2c) PCP and failure analysis. Material and Methods: 200 PCP (95 LR, 86 IR, 19 T2c) 53 ­ 83 y.o. (mean 69) treated between 2011 and 2014. 48% used neoadjuvant ADT. The patients were irradiated every other day with a fraction dose of 7.25 Gy to the total dose 36.25 Gy (5 fractions in 9 days). Fiducials based tracking was performed. The patients were controlled on the treatment completion day, 1, 4, 8 months later and subsequently every 6 months. The PSA concentration, ADT usage, acute and late adverse effects (EORTC/RTOG) and other symptoms were evaluated. FU ranged from 1 to 63.6 months (mean 32.2, median 32.9). Results: The adverse effects percentage was very low; only 1 month after treatment the percentage of acute urinary reaction exceeded 40%. Only single G3 adverse effects were noted. Over 4 months the median PSA concentration declined from 3.75 to 0.27 ng/ml. 9 failures (4.5%) were noted ­ more among IR and patients without neoadjuvant ADT. No failure in the T2c group was found. Median time to failure was 32.4 months. Cox analysis revealed that the failure risk increases with the value of maximal PSA before treatment. Conclusions: CK based radioablation of LR and IR PCP is a safe and highly effective treatment modality. The main prognostic factor of failure after this treatment is probably the maximal PSA concentration before treatment. The neoadjuvant ADT in IR group should be considered. The lack of failures in the T2c group enables us to suggest that even more locally advanced patients (T3) with low PSA and maximal Gleason 3+4 could be treated with this modality.

"Better do not touch" and other superstitions concerning melanoma: the cross-sectional web-based survey.

INTRODUCTION: To the authors' best knowledge, there are no data regarding the prevalence of superstitions concerning melanoma among internet users. AIM: To evaluate the prevalence and identify reasons for superstitions associated with excision of pigmented skin lesions as well as to assess the frequency of this procedure. MATERIAL AND METHODS: Readers of the scientific portal were invited to complete a fully anonymous e-questionnaire. After collection of questionnaires (5,154) and eliminating incomplete ones, 4,919 surveys were analysed. RESULTS: A total of 4,104 (83.4%) respondents have been aware that the total surgical excision is the only efficient way of melanoma treatment. This familiarity was related to increased skin cancer awareness but was not linked to regular skin self-examination. Over half of the surveyed agreed that "it is better not to touch naevi". Moreover, 3,510 (71.3%) individuals believed that naevi located in "harmed places" may turn into melanoma. CONCLUSIONS: Superstitions associated with surgical treatment of melanoma are widespread. Conducting educational campaigns is necessary, particularly among young people, whose dangerous tanning behaviours are important risk factors for melanoma occurrence in their later life.

Melanoma awareness and prevalence of dermoscopic examination among internet users: a cross-sectional survey.

INTRODUCTION: Melanoma presents the greater threat to health the later the disease is detected and treated, although treatment results can be improved by the widespread use of dermoscopy. However, scarce data are available concerning the awareness of dermoscopy and the frequency of its performance in the non-patient population. AIM: To assess the awareness of melanoma detection by dermoscopic examination among the audience of a scientific website. MATERIAL AND METHODS: Respondents were invited to participate in an online cross-sectional survey. They were asked to complete an online questionnaire designed by the authors. The preliminary analysis of 5,154 collected forms and the exclusion of incomplete forms yielded 4,919 fully completed questionnaires; the resulting database was analyzed statistically using logistic regression with the R software program (95% CI). RESULTS: Less than two-fifths (39.2%) of respondents reported ever having sought the advice of a medical professional (dermatologist or other specialist), and 25.4% of the respondents had undergone dermoscopy at least once in their life. Furthermore, approximately one-tenth of respondents (10.7%) were not aware of this detection tool. The study respondents gained knowledge about dermoscopic examination from television and magazines. The performance of dermoscopy was more increasingly associated with inhabitants of larger locales, the use of higher-SPF sunscreens, and greater awareness of the relationship between the risk of melanoma and sunburn. CONCLUSIONS: Awareness of melanoma and sun care varied within the analyzed population. A subset of individuals at high risk of melanoma was identified. This group included those who engaged in risky sun exposure behaviors and who had never been examined by dermoscopy.

A comparison of an antibacterial sandwich dressing vs dressing containing silver.

The purpose of this study was to compare the efficacy of dressings containing octenidine vs. dressings containing silver in the wound healing in the course of a chronic venous disease. There were two groups of 40 patients who met the inclusion criteria and who did not meet the exclusion criteria. The patients were randomly assigned into the groups (envelope method). The first, "O group" was treated with octenidine-based dressings. The second, "S group" was treated with silver dressings. The study lasted for 56 days. All patients in the research were treated with medical compression stockings with cotton understockings. Microbiological eradication was observed on the 28th day of the study among 33% of patients in the treatment group vs. 6% in control group. On the 56th day of the treatment, these percentages equalled 72% and 35%. The rate of healing was faster in the 0 group than in the S group. In the wounds <10 cm(2) it was faster by 1.35 cm(2)/week and in wounds >10 cm(2) it equalled 3.44 cm(2). The reduction of pain level was 37.5% higher in the O group, in contrast with the S group. One change of a dressing in the O group led to a 0.06 cm(2) greater wound size reduction and in the case of wounds >10 cm(2) to 0.29 cm(2) reduction compared with the S group. The presented results indicate that the efficacy of dressings containing octenidine is higher compared to silver dressings.

Does routine clinical practice reproduce the outcome of large prospective trials? The analysis of institutional database on patients with limited-disease small-cell lung cancer.

We performed the analysis of database on 409 patients with LD-SCLC to evaluate as to what extent the clinical outcome of large prospective trials was reproduced in routine practice. The analysis has shown that the hazard rate of death in the absence of prophylactic cranial irradiation (PCI) adjusted for the effects of confounding factors, appeared larger than that reported in the trials on PCI in LD-SCLC, and was comparable to that estimated for extensive disease. Less intense routine staging procedures, compared to the trial settings, contributed for such outcome. Hyperfractionated thoracic radiotherapy provided survival advantage similar to that reported in the literature.

Interrelation between population density and cancer incidence in the province of Opole, Poland.

AIM OF THE STUDY: In this study, we present the results of the interrelation between population density and cancer incidence in the Province of Opole, Poland. MATERIAL AND METHODS: The material included demographic data from the Statistical Office in Opole and oncology information obtained from the Cancer Registry in Opole - both research series encompass the five-year plan (years 2006-2010). A geostatistic analysis was performed using a spatial model (called the conditional autoregressive model). Based on the spatial regression coefficients, the strength of the relationship was measured in male and female populations, respectively. The statistical computations were performed in the Bayesian Inference Using Gibbs Sampling (BUGS) platform based on the so-called Markov Chain Monte Carlo (MCMC) technique. RESULTS: The data presented in the study indicate that relative risk of cancer is higher within urban than in rural areas; an increase in population density of a thousand people per sq. km results in a 13% increase in risk of cancer among men and 16% increase in this risk for women.

Dermoscopy of Chronic Radiation-Induced Dermatitis in Patients with Head and Neck Cancers Treated with Radiotherapy.

Radiotherapy (RT) is an integral part of many cancer treatment protocols. Chronic radiation-induced dermatitis (CRD) is a cutaneous toxicity that occurs in one-third of all patients treated with this method. CRD is usually observed several months after completion of treatment. Typical symptoms of CRD are telangiectasia, skin discoloration, atrophy, thickening, and cutaneous fibrosis. There are currently no data in the literature on the evaluation of the dermoscopic features of CRD. The aim of this prospective study was the identification of clinical and dermoscopic features in a group of 32 patients with head and neck cancer (HNC) in whom CRD developed after RT. CRD was assessed at 3, 6, and 12 months after RT in 16, 10, and 10 patients, respectively. CRD was assessed at one time point and two time points in 28 and 4 patients, respectively. The control included skin areas of the same patient not exposed to RT. The dataset consisted of 36 clinical and 216 dermoscopic photos. Clinical evaluation was performed according to the RTOG/EORTC radiation-induced dermatitis scale. The highest score was grade 2 observed in 21 patients. Clinical observations revealed the presence of slight and patchy atrophy, pigmentation change, moderate telangiectasias, and some and total hair loss. Dotted vessels, clustered vessel distribution, white patchy scale, perifollicular white color, white structureless areas, brown dots and globules, and white lines were the most frequently noted features in dermoscopy. Three independent risk factors for chronic toxicity, such as age, gender, and surgery before RT, were identified. The dermoscopic features that had been shown in our study reflect the biological reaction of the skin towards radiation and may be used for the parametrization of CRD regarding its intensity and any other clinical consequences in the future.

Unlocking the Potential of Adequate Bacillus Calmette-Guérin Immunotherapy in Very-high-risk Non-muscle-invasive Bladder Carcinoma: A Multicenter Analysis of Oncological Outcomes and Risk Dynamics.

BACKGROUND: The European Association of Urology (EAU) recommends discussing upfront radical cystectomy for all patients with very high risk (VHR) non-muscle-invasive bladder carcinoma (NMIBC), but the role of bacillus Calmette-Guérin (BCG) treatment remains controversial. OBJECTIVE: To analyze oncological outcomes in VHR NMIBC patients (EAU risk groups) treated with adequate BCG. DESIGN, SETTING, AND PARTICIPANTS: A multi-institutional retrospective study involving patients with VHR NMIBC who received adequate BCG therapy from 2007 to 2020 was conducted. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: A survival analysis estimated recurrence-free survival (RFS), progression-free survival (PFS), and the cumulative incidence of cancer-specific mortality (CSM) after accounting for other causes of mortality as competing risk events and of the overall mortality (OM). Conditional survival probabilities for 0-4 yr without events were computed. Cox regression assessed the predictors of oncological outcomes. RESULTS AND LIMITATION: A total of 640 patients, with a median 47 (32-67) mo follow-up for event-free individuals, were analyzed. High-grade RFS and PFS at 5 yr were 53% (49-57%) and 78% (74-82%), respectively. The cumulative incidence of CSM and OM at 5 yr was 13% (10-16%) and 16% (13-19%), respectively. Conditional RFS, PFS, overall survival, and cancer-specific survival at 4 yr were 91%, 96%, 87%, and 94%, respectively. Cox regression identified tumor grade (hazard ratio [HR]: 1.54; 1.1-2) and size (HR: 1.3; 1.1-1.7) as RFS predictors. Tumor multiplicity predicted RFS (HR: 1.6; 1.3-2), PFS (HR: 2; 1.2-3.3), and CSM (HR: 2; 1.2-3.2), while age predicted OM (HR: 1.48; 1.1-2). CONCLUSIONS: Patients with VHR NMIBC who receive adequate BCG therapy have a more favorable prognosis than predicted by EAU risk groups, especially among those with a sustained response, in whom continuing maintenance therapy emerges as a viable alternative to radical cystectomy. PATIENT SUMMARY: Our research shows that a sustained response to bacillus Calmette-Guérin in patients can lead to favorable outcomes, serving as a viable alternative to cystectomy for select cases.

A faster reconstitution of hematopoiesis after autologous transplantation of hematopoietic cells cryopreserved in 7.5% dimethyl sulfoxide if compared to 10% dimethyl sulfoxide containing medium.

Our previous in vitro studies proved a higher clonogenic potential of peripheral blood progenitor cells cryopreserved in 7.5% dimethyl sulfoxide (Me2SO) than in 10% Me2SO containing medium. Based on this findings 7.5% Me2SO cryopreservation medium was introduced to our protocol and both the hematopoietic recovery and infusion-related toxicity were compared with that obtained with standard 10% Me2SO containing solution. Two cohorts of consecutive patients treated with autologous hematopoietic stem cell transplantation were included in the analysis: 56 patients with PBPCs cryopreserved in 7.5% Me2SO solution and 52 patients who obtained cells cryopreserved in 10% Me2SO. Both study groups did not differ significantly with regard to age, diagnosis, and the number of transplanted CD34(+) cells. The time to leukocyte recovery was shorter for patients in the 7.5% Me2SO treated group than in the 10% one. Reconstitution of platelets and the frequency of adverse events did not differ in both groups. Reduction of Me2SO concentration from 10% to 7.5% in cryoprotective mixture has a beneficial impact on leukocyte recovery. These findings require verification in a prospective, randomized trial.