Common Pathways for Pain and Depression-Implications for Practice.

BACKGROUND: Pain and depression have a high impact on caring for the people who need palliative care, but both of these are neglected compared with the approach for other symptoms encountered by these patients. AREAS OF UNCERTAINTY: There are few studies in humans that support the existence of common neural circuits between depression and pain that also explore the use of drugs with effects in both conditions. More knowledge is needed about the relationship of these clinical entities that will lead to the optimization of the treatment and improvement of quality of life. DATA SOURCES: We conducted a search in PubMed to identify relevant articles and reviews that have been published in the last 5 years, concerning the topic of common pathways between depression and pain (2014-April 2019). THERAPEUTIC ADVANCES: The connections between the 2 clinical entities start at the level of the cortical regions. The hippocampus is the main site of neural changes, modification of the immune system, neuromodulators, neurotransmitters, and signaling pathways implicated in both conditions. Increased levels of peripheral proinflammatory cytokines and neuroinflammatory changes are related to the physiopathology of these entities. Inflammation links depression and pain by altering neural circuits and changes in their common cortical regions. Antidepressants are used to treat depression and chronic, pain but more experimental studies are needed to determine which antidepressant drugs are the most effective in treating the 2 entities. CONCLUSIONS: Pharmacological and nonpharmacological interventions targeting cortical changes in pain and depression are promising, but more clinical studies are needed to validate their usefulness.

Low Response to Clopidogrel in Coronary Artery Disease.

BACKGROUND: In patients with coronary artery disease, cardiovascular mortality and other acute events showed a clear correlation with risk factors and biomarkers including platelet activation. STUDY QUESTION OF THIS RESEARCH: Which was the incidence of low response to clopidogrel and its correlation with risk factors and biomarkers in coronary artery disease? STUDY DESIGN: Four hundred patients (pts) with coronary artery disease-stable angina (SA) and acute coronary syndrome-were divided into 8 groups of study, consistent with low response to clopidogrel and the type of coronary artery disease. Low response to clopidogrel-defined as adenosine diphosphate test-ADP-test of >46 U by multiple electrode platelet aggregometry was evaluated in correlation with cardiovascular risk factors and biomarkers of oxidative stress, endothelial dysfunction, hypercoagulability, high platelet reactivity. RESULTS: In coronary artery disease, low response to clopidogrel significantly correlated with older than 65 years, smoking, hypertension, diabetes mellitus, body mass index of >25, previous aspirin treatment (P < 0.05), high value of total and low-density lipoprotein cholesterol, low value of high-density lipoprotein cholesterol, low response to aspirin, high mean platelets volume and von Willebrand factor activity, low flow-mediated vasodilatation, total antioxidant status (P < 0.01) and only in patients with SA of male gender (P < 0.01). The incidence of other hypercoagulability biomarkers, such as reduced values of S protein, C protein, antithrombin III, and V Factor Leiden resistance to activated protein C, was very low and not correlated with low response to clopidogrel. CONCLUSIONS: In coronary artery disease, low response to clopidogrel significantly correlated with the most of old cardiovascular risk factors, with previous aspirin treatment, low response to aspirin, higher mean platelets volume, higher von Willebrand factor activity, lower flow-mediated vasodilatation, and lower total antioxidant status values and only in patients with SA of male gender.

Patients' perceptions of healthcare professionalism-a Romanian experience.

BACKGROUND: The main objective of this cross sectional study was to assess the psychometric properties of a new research instrument. The secondary aim was to analyze patients' levels of dissatisfaction with the professionalism of medical staff. METHODS: A social survey questionnaire was created and administered online. The instrument consisted of two scales: the 30-item patient dissatisfaction scale and the 10 items institutional scale. In this article, we assessed only the patient dissatisfaction scale. The research population includes 1838 subjects. The statistical procedures used were descriptive statistics, Pearson's correlation, and factorial analyses with the SPSS.19 software. The internal consistency of the instrument was determined using the Cronbach's alpha coefficient. We used a principal component analysis to investigate the factorial validity of the scale. RESULTS: The patients' scale of dissatisfaction obtained an alpha Cronbach score of 0.81. Three latent factors corresponding to three dimensions of dissatisfaction emerged from the data: medical staff's ability to communicate, medical staff's hygiene, as well as sanitary and privacy conditions within the hospital. The first factor explained 43.47% of the variance in patient dissatisfaction, the second factor explained 10.24%, and the third factor explained 7.59%; overall, the three factors explained 61.30% of the total variance. CONCLUSION: The Romanian healthcare system has an organization and management structure which has shown few changes since the communist period. Our study indicates that although more than 25 years have passed since the political regime changed in Romania and the introduction of a different system of social care, there have been no corresponding changes in the medical staff's mentality or in the way that patients are approached. The present assessment of patient dissatisfaction is not a strictly theoretical exercise; it also represents a valuable instrument for healthcare system management.

Analysis of breast cancer subtypes and their correlations with receptors and ultrasound.

The study aim was to evaluate the ultrasound (US) signs of the mammary lesions classified in the Breast Imaging-Reporting and Data System (BI-RADS) score category 3, 4, and 5, corresponding to US BI-RADS. It also followed the correlation between US changes of lesions suggestive for malignancy with the histopathological results and evaluated the proper management of those lesions. There were correlations of breast cancer (BC) subtypes with the receptors [estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2)], and Ki67 index, and the signs of conventional ultrasonography and US elastography. We selected 108 female patients examined with US, mammography and fine-needle biopsy who presented suspicions for malignancy lesions. Following the immunohistochemical analysis, they were classified in one of the BC subtypes. According to chi-squared analysis of molecular cancer subtypes correlation to receptors and Ki67 index, we found significant associations between both luminal A and luminal B HER2-negative subtypes and hormone receptors (ER, PR). These have an inverse relationship with Ki67 index elevated values; luminal B HER2-positive subtype has a direct association with HER2 presence; HER2-enriched subtype was statistically significant associated to HER2 presence and elevated Ki67 index values but had an inverse relationship to hormone receptors (ER, PR); triple-negative subtype was strongly associated to Ki67 index values and inversely correlated to ER and PR. We found luminal A subtype as being the most common and luminal B HER2-positive subtype as having the fewer cases.

Ethical approach to the genetic, biometric and health data protection and processing in the new EU General Data Protection Regulation (2018).

PURPOSE: The main purpose of the present paper is to analyze the rules for processing of special categories of personal data (genetic data, including biological samples, biometric and health data) in the light of the new General Data Protection Regulation (GDPR), thus contributing to overview the health status and the biomedical state of the data subject. BACKGROUND: Over the last two decades, debating the European Union's (EU) major legislation with regard to personal data and patients' rights became relevant for the scientific research. The paper assesses the basic legal provisions with regard to the genetic, biometric and data concerning health considered as "sensitive data", while safeguarding the ethical standards of the scientific research. The present article investigates the ethical and legal approaches to processing personal data in the understanding of the new regulatory guidelines regarding the data protection, here including the health status and the rights of a data subject. CONCLUSIONS: The protection of natural persons with regard to the processing of genetic, biometric and health data and the free movement of such data are reinforced in the new GDPR entered into force in May 2016 and applied from 25 May 2018. The new legal context elucidates: the special categories of personal data ("sensitive data"), the "consent" and the research exemption by explicitly recognizing the "pseudonymised" data. Although the new guidelines revisit the EU data protection reform, it also grants the EU Member States the right to maintain or introduce further limitations to the processing of such data.

The role of the personality traits and work characteristics in the prediction of the burnout syndrome among nurses-a new approach within predictive, preventive, and personalized medicine concept.

BACKGROUND: The burnout syndrome is characterized by emotional exhaustion, depersonalization, and lack of personal accomplishment. It was identified in some professional categories, the most often being affected those in public health services. OBJECTIVES: This study mainly aims to identify and analyze the value of the personality traits and work characteristics as predictive factors for the occurrence of the burnout syndrome in nurses, under the new approach of predictive, preventive, and personalized medicine. METHOD: A total of 192 nurses were included in the study. The NEO-Five-Factor Inventory, the Copenhagen Burnout Inventory, and the Inventory of Nursing Work Characteristics were administered to all of the participants. RESULTS: Some personality traits proved to be predictive factors for the occurrence of the burnout syndrome. Neuroticism, negative self-esteem, and negative emotionality predict burnout vulnerability. The negative correlations between sociability and the burnout dimensions show that the positive affectivity of the extraverted individuals and the strong positive orientation of the extraverts towards others are protective factors against burnout. There are also significant associations between certain personality traits and nursing work characteristics (work overload, the existence of problems in the department, and satisfaction in the professional and family life), which could be defined, also, as predictive factors for burnout. CONCLUSIONS: This study confirms the influence of the Big Five personality traits and nursing work characteristics as predictive factors of the burnout occurrence, opening real possibilities to perform a targeted prevention and provide personalized interventions as organizational services.

Correlations on the protection of personal data and intellectual property rights in medical research.

PURPOSE: International regulations regarding the protection of individuals concerning the processing of personal data and the free movement of such data highlight the need for their systematization and customization, depending on the purpose for which they are collected and used. BACKGROUND: Medical legislation is structured so that the constitutional right to healthcare is guaranteed and at the same time be protected by respecting the right to privacy with respect to identity, physiological state of the person and the way this, by health maneuvers, was restored. European Union (EU) legislation is more and more complex related to the patients' right and also to the General Data Protection Regulation (GDPR). After the Second World War, in all Europe the problem related to the human rights become a sensible one in all countries and become aware the importance of clear rules for protecting people, to develop and protect their rights. CONTENT: The article presents the correlation between personal data and intellectual property right in the field of medical research, one of the most dynamic fields of scientific research both in the field of fundamental and applied research. Dissemination of medical information collected through scientific works is subject to the fact that progress in any field should be encouraged, in order to increase the quality of life while, at the same time, creating a balance between the interests of the researcher and the public interest and the interest of the academic community represented by any person in the situation of recourse to a medical service. CONCLUSIONS: In the context of the EU guidelines and implementation of GDPR starting to 2018, the medical research and the education of scientific researchers in the field has gone into a new stage of the ethical approach.

Diabetic foot - epidemiological and histopathological aspects.

Our study included a total of 259 patients with diabetes, who were admitted to the Department of Plastic Surgery and Reconstructive Microsurgery of the Emergency County Hospital of Pitesti, Romania, in 2016, with the diagnosis of "diabetic foot". Of the 259 patients, 55 (21.23%) were diagnosed with type 1 diabetes, and the remaining 204 (78.77%) were diagnosed with type 2 diabetes; the ratio of type 1∕type 2 diabetes was 1∕3.7. The injuries presented by the patients were osteitis (27.81%), moist gangrene (21.62%), abscesses (18.92%), cellulitis (11.19%), various forms of fasciitis (8.88%), perforating strand (6.18%), and dry gangrene (5.4%). The disease was most commonly diagnosed in males in the rural environment. Most of the patients were in the age group of 61-70 years old. All patients were surgically treated, but 142 (54.82%) patients needed amputations of foot segments (fingers, metatarsal or tarsal bones). The histopathological and immunohistochemical study on excised fragments revealed the existence of a chronic inflammatory process formed mainly from macrophages, mast cells and CD4+ T-lymphocytes.

Evaluation of Helicobacter pylori infection in patients with eso-gastro-duodenal pathology.

Helicobacter pylori (HP) infection is one of the most frequent bacterial infections in humans. The studies performed in the last 30 years showed that this bacterium is the main cause of chronic gastritis and the main etiological agent of peptic ulcer and gastric cancer. We investigated the prevalence of HP infection in a group of 1525 patients who addressed a gastroenterology medical center between 2010-2014, in Craiova, Romania, for dyspeptic symptoms. The patients underwent a clinical, endoscopic and serologic investigation for highlighting a possible HP infection. The age of the patients with gastric duodenal pathology varied between 16 and 87 years old. Of the 1525 patients, a number of 971 (63.67%) were diagnosed with HP infection, while the rest of 554 (36.33%) were not infected. The study on the distribution of gastric duodenal pathology and HP infection showed that the lesions of the upper digestive tract and HP infection emerged quite early, a number of 29 patients being aged less than 20 years old; among these, 21 (72.41%) patients were HP positive and only eight (27.59%) were HP negative. In the age group of 20-29 years old there were recorded 184 patients, of which 120 (65.22%) were HP positive and only 64 (34.78%) were HP negative. There may be observed that in the age group of 20-29 years old, both the patients with gastric duodenal pathology and the ones with HP infection increased six times in comparison to the first decade. Most cases were recorded in the patients aged between 50 and 69 years old. The two decades comprised a total number of 607 (39.8%) patients, of which 375 (61.78%) were HP positive and 232 (38.22%) were HP negative. By evaluating the distribution of HP infection according to the social environment, there was observed that there were no significant differences between the patients coming from the urban area and the ones from the rural area, as far as the HP infection was concerned.

Ethical dilemmas in communicating bad news following histopathology examination.

PURPOSE: The study proposes an analysis of the ethical aspects that occur in communicating bad news following histopathology laboratory tests in medical practice, in particular in the case of the anatomical pathology diagnosis confirming a medical condition of poor prognosis. BACKGROUND: Over the last decades, the progress of science and technology in the medical field, as well as the explosive increase of specialist information available on the Internet have led to unprecedented ethical issues related to the communication modality of histopathology test results to patients. CONTENT: The paper analyses from an ethical and legislative perspective the main ethical dilemmas that occur when choosing a modality for communicating test results. DISCUSSION AND CONCLUSIONS: While communicating bad news is an essential ability for medical professionals, it should be used within the context of observing the patients' right to decide whether they wish to receive such information or not and their right to their own autonomy, by means of a personalized protocol for communicating bad news in current medical practice.

Bioethical dilemmas in using animal in medical research. Challenges and opportunities.

PURPOSE: The study aims to present the main ethical dilemmas that research on animals raised for anyone involved in this process, starting from the idea that there are rights of animals to be known and respected. BACKGROUND: The evolution of medicine is inextricably linked to the production of new drugs, the occurrence of surgical techniques; none of these can be possible without the study of experimental animals, in vivo experimentation being part of the process of medical research. CONTENT: The article analyzes the main ethical dilemmas related to the use of animals in medical research, in the current legislative context and historical perspective of achieving such studies. DISCUSSION AND CONCLUSIONS: The use of animals in medical research must be conducted in accordance with clearly established moral rules, which facilitate reducing to the maximum the negative effects on the animals, avoiding unnecessary suffering to them and especially to facilitate progress achievement with the minimum possible animals sacrificed.

S100-positive dendritic cells in squamous cell laryngeal cancer.

Dendritic cells (DC) are the most potent antigen-presenting cells, and induce antigen-specific immune responses. DC are believed to evolve into tumor-antigen pulsed cells and then to migrate to local lymph nodes, where they activate anti-tumor immune responses. This theory is supported by studies showing that high DC densities are associated with favorable prognosis in some tumor types. In the present study, we evaluated 40 primary and metastatic laryngeal carcinomas for the presence of DC, using immunohistochemistry with the anti-S100 protein antibody. We analyzed the relationship between the degree of infiltration by S100-positive (S100+) DC and prognostic factors, including histological subtype, histological grade, peritumor inflammatory infiltration, and stromal desmoplasia. The results show that in all evaluated laryngeal cancers S100-positive cells were significantly more frequent in the tumor stroma. Primary tumors with nodal metastases showed more significant differences in intraepithelial and stromal DC distribution than tumors without nodal metastases. A significant higher S100+ DC was also noticed in the desmoplasic stroma of lymph nodes. The subtype with keratinization had a significant higher S100-positive cells infiltration than the adenoid÷transitional subtype. The infiltration rate of intraepithelial S100+ DC was much higher in well-differentiated (G1) tumors. No significant correlation between S100-positive cells and peritumoral inflammatory infiltration and stromal desmoplasia was found. In conclusion, dendritic cells need multiple, much more complex investigations. This work should be regarded as a preliminary investigation.

Prevalence and histopathological types of skin carcinomas in Arges County, Romania.

Non-melanoma skin cancers presented a significant incidence increase in the last decades, worldwidely. Even though the impact upon mortality is a relatively low one, through the incidence increase, their impact upon the public healthcare systems is a considerable one. In our study, we evaluated 109 cases of skin carcinomas hospitalized during 2012 in the Department of Plastic Surgery of the Emergency Hospital of Pitesti, Romania, for a surgical treatment. The gender distribution showed slight lesion predominance in women, being recorded 56 (51.38%) tumors in women and 53 (48.62%) in men. The highest incidence of skin carcinomas (75.23%) was recorded in the persons aged over 60-year-old. Of 109 cases of skin carcinomas, 80 (73.4%) carcinomas developed on indignant tegument areas, while 29 (26.6%) on premalignant skin lesions (fiberconjunctive papillomas, keratocantomas, keratosic verrucas). The histopathological study highlighted the fact that of 109 skin carcinomas, 87 (79.82%) were basal cell carcinomas and only 22 (20.18%) were squamous cell carcinomas. The immunohistochemical reaction to 34ßE12 cytokeratin was highly positive in the cells of the basal cell carcinomas and well-differentiated squamous cell carcinomas (except for the "keratosic pearls") and moderately positive in the moderately differentiated squamous cell carcinoma.