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During the COVID-19 pandemic, cancellations and rescheduling significantly extend the waiting time for outpatient appointments and surgical procedures. A network of expert high-volume centres, at every level of referentiality, should guarantee the continuity of oncological care, supported with telemedicine systems.The COVID-19 pandemic has caused a substantial decrease in clinical activity of urology residents. There also is huge potential for remote technology to address and improve education and training continuation in this field.
Urological care has been severely impaired by the COVID-19 pandemic. Urologists must adapt to the dynamically changing reality, prioritizing the safety and well-being of their patients and their clinic workforce.
Urological care has been severely impaired by the COVID-19 pandemic. Urologists must adapt to the dynamically changing reality, prioritizing the safety and well-being of their patients and their clinic workforce.
Social distancing is considered the best strategy to prevent the spread of COVID-19 (COronaVIrus Disease 19). We aimed to analyse the effect of 'social distancing' on the emotional state, post-operative pain and functional outcomes of patients undergoing robot-assisted radical prostatectomy (RARP).
We retrospectively reviewed data of male patients who underwent RARP within the study period (from March to April 2019 [Group A = 27 patients] and from March to April 2020 [Group B = 29 patients]). Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) results were collected on the first day of hospitalization. Post-operative pain was assessed using the numerical rating scale (NRS) and visual analogic scale (VAS) after surgery in the post-anesthesia care unit (PACU) and at 24 hours. Functional outcomes were evaluated at the one-month follow-up. Demographic, pathological and peri-operative data were collected for all patients.
There were no significant differences in demographics andate, as well as influencing post-operative pain, early urinary continence and desire for sexual rehabilitation.
The COVID-19 pandemic poses significant challenges to healthcare facilities and as per social distancing measures, many consultations are now being carried out via means of telemedicine. As some urologists may not be skilled with remote consultations, there is a need for recommendations on patient-centered online medical counseling.
We have identified eight areas of excellence and defined the principles based on our experience.
A professional setting should be provided, in which the privacy of the patient can be ensured. Accompanying persons should be encouraged into the consultation. Proper introduction could serve not only to verify the personality of the patient, but also to provide them with a sense of confidentiality. selleck kinase inhibitor The interview should be held in a way to overcome the limitations of non-physical encounters, and pande-mic-specific issues should be taken into consideration. When arranging plans, the physician should judge accordingly in regards to what type of management is inevitable or safe, as well as available at this point; strict follow-up should be arranged. As home isolation may lead to unfavorable changes in lifestyle, this issue should be addressed too. The patient should be guided on how to self-educate. Concluding the visit should be aimed at proper evaluation of the patient's comprehension of the consultation.
It is vital to pursue consistency in providing care to patients. While online counseling may seem challenging, if one adheres to the principles of patient-centered practice, telemedicine may become a valuable tool in maintaining the best-quality care amid the ongoing pandemic.
It is vital to pursue consistency in providing care to patients. While online counseling may seem challenging, if one adheres to the principles of patient-centered practice, telemedicine may become a valuable tool in maintaining the best-quality care amid the ongoing pandemic.
Poland was initially less affected by the coronavirus disease 2019 (COVID-19) pandemic, however, severe restrictions, and health care restructuration have impacted all areas of medicine, including urology. Therefore, we aimed, via an online survey, to examine the impact of the COVID-19 pandemic on Polish urologists and urology residents.
Between May 15 and June 6, 2020, 229 (28.63% response rate) urologists and urology residents responded to a 28-question online survey. The questionnaire analyzed basic demographic and professional characteristics, and the impact of the COVID-19 pandemic on physicians' everyday work, mental status as well as private life. We further compared the differences between the selected subgroups.
Nearly all (96.5%) responders claimed that the pandemic had a moderate to high impact on their everyday clinical practice with the majority of the residents (62.0%) believing that the COVID-19 pandemic will harm their training. Most responders (86.9%) reported over 25% declines in outpatient clinic consultations and 55.9% claimed that their income dropped over 25%. Only 38.9% wanted telemedicine to permanently replace some of the consultations after the pandemic, with residents being significantly more positive about this modality (51.4% vs. 33.1%; p = 0.01). Interestingly, 79.9% noticed the negative psychological effect of the pandemic on their colleagues, and 57.6% felt increased anxiety, sadness, or stress.
This study revealed the complaints and needs of Polish urologists and urology residents after the first wave of the COVID-19 pandemic. There was a significantly negative impact on their work, mental health, and private life.
This study revealed the complaints and needs of Polish urologists and urology residents after the first wave of the COVID-19 pandemic. There was a significantly negative impact on their work, mental health, and private life.Data subject to length-biased sampling are frequently encountered in various applications including prevalent cohort studies and are considered as a special case of left-truncated data under the stationarity assumption. Many semiparametric regression methods have been proposed for length-biased data to model the association between covariates and the survival outcome of interest. In this paper, we present a brief review of the statistical methodologies established for the analysis of length-biased data under the Cox model, which is the most commonly adopted semiparametric model, and introduce an R package CoxPhLb that implements these methods. Specifically, the package includes features such as fitting the Cox model to explore covariate effects on survival times and checking the proportional hazards model assumptions and the stationarity assumption. We illustrate usage of the package with a simulated data example and a real dataset, the Channing House data, which are publicly available.Streamflow duration is used to differentiate reaches into discrete classes (e.g., perennial, intermittent, and ephemeral) for water resource management. Because the depiction of the extent and flow duration of streams via existing maps, remote sensing, and gauging is constrained, field-based tools are needed for use by practitioners and to validate hydrography and modeling advances. Streamflow Duration Assessment Methods (SDAMs) are rapid, reach-scale indices or models that use physical and biological indicators to predict flow duration class. We review the scientific basis for indicators and present conceptual and operational frameworks for SDAM development. Indicators can be responses to or controls of flow duration. Aquatic and terrestrial responses can be integrated into SDAMs, reflecting concurrent increases and decreases along the flow duration gradient. The conceptual framework for data-driven SDAM development shows interrelationships among the key components study reaches, hydrologic data, and indicators. We present a generalized operational framework for SDAM development that integrates the data-driven components through five process steps preparation, data collection, data analysis, evaluation, and implementation. We highlight priorities for the advancement of SDAMs, including expansion of gauging of nonperennial reaches, use of citizen science data, adjusting for stressor gradients, and statistical and monitoring advances to improve indicator effectiveness.Apoptosis has long been recognized as a mechanism that kills the cancer cells by cytotoxic drugs. In recent years, studies have proved that pyroptosis can also shrink tumors and inhibit cells proliferation. Both apoptosis and pyroptosis are caspase-dependent programmed cell death pathways. Cysteinyl aspartate specific proteinase-3 (Caspase-3) is a common key protein in the apoptosis and pyroptosis pathways, and when activated, the expression level of tumor suppressor gene Gasdermin E (GSDME) determines the mechanism of tumor cell death. When GSDME is highly expressed, the active caspase-3 cuts it and releases the N-terminal domain to punch holes in the cell membrane, resulting in cell swelling, rupture, and death. When the expression of GSDME is low, it will lead to the classical mechanism of tumor cell death, which is apoptosis. More interestingly, researchers have found that GSDME can also be located upstream of caspase-3, connecting extrinsic, and intrinsic apoptotic pathways. Then, promoting caspase-3 activation, and forming a self-amplifying feed-forward loop. GSDME-mediated pyroptosis is correlated with the side effects of chemotherapy and anti-tumor immunity. This article mainly reviews the caspase-3/GSDME signal pathway as a switch between apoptosis and pyroptosis in cancer, to provide new strategies and targets for cancer treatment.Platinum chemotherapies are highly effective cytotoxic agents but often induce resistance when used as monotherapies. Combinatorial strategies limit this risk and provide effective treatment options for many cancers. Here, we repurpose atovaquone (ATQ), a well-tolerated & FDA-approved anti-malarial agent by demonstrating that it potentiates cancer cell death of a subset of platinums. We show that ATQ in combination with carboplatin or cisplatin induces striking and repeatable concentration- and time-dependent cell death sensitization in vitro across a variety of cancer cell lines. ATQ induces mitochondrial reactive oxygen species (mROS), depleting intracellular glutathione (GSH) pools in a concentration-dependent manner. The superoxide dismutase mimetic MnTBAP rescues ATQ-induced mROS production and pre-loading cells with the GSH prodrug N-acetyl cysteine (NAC) abrogates the sensitization. Together, these findings implicate ATQ-induced oxidative stress as key mediator of the sensitizing effect. At physiologically achievable concentrations, ATQ and carboplatin furthermore synergistically delay the growth of three-dimensional avascular spheroids. Clinically, ATQ is a safe and specific inhibitor of the electron transport chain (ETC) and is concurrently being repurposed as a candidate tumor hypoxia modifier. Together, these findings suggest that ATQ is deserving of further study as a candidate platinum sensitizing agent.Epidermal differentiation is a complex process that requires the regulated and sequential expression of various genes. Most fused-type S100 proteins are expressed in the granular layer and it is hypothesized that these proteins may be associated with cornification and barrier formation. We previously identified a member of the fused-type S100 proteins, Trichohyalin-like 1 (TCHHL1) protein. TCHHL1 is distributed in the basal layer of the normal epidermis. Furthermore, the expression is markedly increased in cancerous/non-cancerous skin samples with the hyperproliferation of keratinocytes. We herein examined the role of TCHHL1 in normal human keratinocytes (NHKs) and squamous cell carcinoma (SCC). The knockdown of TCHHL1 by transfection with TCHHL1 siRNA significantly inhibited proliferation and induced the early apoptosis of NHKs. In TCHHL1-knockdown NHKs, the level of extracellular signal-regulated kinase 1/2 (ERK1/2) phosphorylation was markedly decreased. In addition, the slight inhibition of v-akt murine thymoma viral oncogene homolog (AKT) phosphorylation and upregulation of forkhead box-containing protein O1(FOXO1), B-cell lymphoma2 (BCL2) and Bcl2-like protein 11 (BCL2L11) was observed.
