Clinicopathological characteristics and prognostic outcomes of bladder urothelial neoplasms in patients under 40 years of age: a multicenter retrospective study

Bladder cancer is rare in patients under 40 years of age, and its clinicopathological behavior in this demographic remains a subject of debate. This study aimed to evaluate the histopathological features and prognosis of bladder tumors in patients under the age of 40. This multicenter retrospective study included bladder transurethral resection, biopsy, and cystectomy samples obtained from patients younger than 40 years of age across 20 centers in Turkiye between 2010 and 2025. Among 1,555 biopsies, 445 patients were diagnosed as urothelial neoplasms. After exclusion of 45 patients lacking hematoxylin and eosin stained slides for re-evaluation, 400 urothelial neoplasms were included in the final cohort. All patients were centrally reviewed by three genitourinary pathologists to establish a consensus diagnosis. Demographic characteristics, clinical presentation, tumor localization, pathological stage, and histological subtypes were analyzed. Follow-up data were available for 206 patients and were used to evaluate clinical outcomes. Statistical analyses were performed using chi-square tests with post-hoc analysis based on adjusted standardized residuals. Low-grade papillary urothelial carcinoma (LGPUC) was the most frequent diagnosis, accounting for 233/400 patients (58.3%), followed by papillary urothelial neoplasm of low malignant potential (PUNLMP) in 55/400 patients (13.8%) and high-grade papillary urothelial carcinoma (HGPUC) in 32/400 patients (8.0%). Overall, 340/400 tumors (85.0%) were non-invasive, whereas 60/400 tumors (15.0%) were invasive. Hematuria was the most common presenting symptom, observed in 197/400 patients (49.3%). Diagnostic revisions after central review were identified in 127/400 patients (31.8%), most commonly involving reclassification between PUNLMP and LGPUC. Age-group analysis demonstrated that urothelial neoplasms occurred most frequently in the 31-40-year age group, which showed a significantly higher proportion of HGPUC and invasive tumors (p < 0.001). Subtype histology or divergent differentiation was identified in 4/60 invasive tumors (6.7%). Among the 206 patients with available follow-up data, remission was observed in 159/206 patients (77.2%), recurrence in 41/206 (19.9%), progression in 2/206 (1.0%), and death in 4/206 patients (1.9%). Adverse clinical outcomes were largely confined to invasive tumors. Bladder tumors in patients under 40 years of age typically exhibit low-grade, low-stage characteristics with a favorable prognosis. Consistent with the literature, the 31–40 age group appears to be a biological transition zone with increased risks of high-grade and invasive carcinoma. Long-term follow-up remains essential due to the potential for recurrence and progression in specific subtypes

Cardiovascular Complications in Hemoglobinopathies: Pathophysiology, Clinical Spectrum, and Management

Sickle cell disease and thalassemia syndromes are increasingly recognized as chronic multisystem disorders, with cardiovascular (CV) sequelae representing a significant proportion of long-term morbidity and mortality. Survival has improved considerably due to better transfusion practice, the administration of iron chelation, and disease-modifying treatments; a broad and expanding phenotypic spectrum of cardiac and vascular manifestations is being recognized. These include cardiomyopathy, heart failure, pulmonary hypertension, arrhythmias, microvascular ischemia, and functional valvular disease, often resulting insidiously and progressing over time. CV pathogenesis of hemoglobinopathies is complex and heterogeneous. Chronic anemia induces a long-lasting high-output circulatory state, while iron overload related to transfusion produces myocardial siderosis, oxidative damage, and electrical instability in particular in transfusion-dependent thalassemia. Moreover, hemolysis-mediated endothelial dysfunction, deficiency of nitric oxide, inflammation, and microvascular pathology play a central role in sickle cell disease, resulting in diastolic dysfunction, pulmonary vascular remodeling, and heart failure with preserved ejection fraction. These pathomechanisms create disease-specific CV phenotypes that have important diagnostic and therapeutic implications. This narrative review was performed by searching the PubMed, Cochrane Library, and Google Scholar databases for original studies, systematic reviews, and guidelines for the period of 2009–2025. This review summarizes available data on the epidemiology and pathophysiological mechanisms contributing to CV complications of hemoglobinopathies and clinical manifestations of CV compromise. The review summarizes developments in diagnosis and screening methods such as echocardiography, cardiac magnetic resonance imaging, biomarkers, and functional measures, disease-modifying drugs, and CV lovastatin by phenotype. We finally highlight major evidence gaps and research priorities needed to improve CV outcomes. This multidisciplinary approach is essential for transforming mechanistic insight into improved survival and quality of life for individuals with hemoglobinopathies through a systematic, interdisciplinary, and proactive CV strategy

The effect of psychoeducation program on hope, stress coping, and psychiatric symptoms in patients with Thalassemia major

Background: Thalassemia major is an inherited public health condition associated with significant psychosocial challenges due to its chronic course and complications. Aim: This study aimed to examine the effect of a psychoeducation program on hope, stress coping, and psychiatric symptoms in patients with thalassemia major. Method: This randomized controlled trial used a pre-test, post-test, and follow-up design. The study was conducted at the Thalassemia Center in the Turkish Republic of Northern Cyprus between January and July 2021. Sixty adult patients were randomly assigned to the intervention (n = 30) and control (n = 30) groups using a computer-generated randomization procedure. Data were collected using the patient information form, Beck Hopelessness Scale, Stress Coping Styles Scale, and Brief Symptom Inventory. The intervention group received an eight-session psychoeducation, while the control group continued with routine care. Results: Significant differences in Beck Hopelessness Scale scores were observed between the intervention and control groups across all measurements. In the intervention group, significant differences were observed in the post-test and follow-up mean scores in the submissive approach and seeking social support approach subscales of the Stress Coping Styles Scale. Analysis of the Brief Symptom Inventory indicated a significant decline in anxiety symptoms at follow-up in the intervention group, while no significant changes were observed in the control group (p < 0.05). Conclusion: The psychoeducation program improved hope levels, promoted adaptive coping strategies, and reduced anxiety symptoms in patients with thalassemia major. Psychoeducation can be used to enhance psychological well-being in this patient group

Bonding Strength of Universal Adhesives to Laser-Etched Deep and Superficial Dentin

Objective: The effectiveness of laser-etching (LE) on dentin shear bond strength (SBS) of universal adhesives remains unclear. This study aimed to compare the SBS of a nanohybrid composite resin to superficial and deep dentin following application of a contemporary universal adhesive using either self-etch (SE) or LE. Materials and Methods: Forty-four extracted human molars were embedded in acrylic blocks and prepared to obtain superficial or deep dentin surfaces (n = 22 each), and then assigned to four groups (n = 11). The Scotchbond Universal Adhesive (SBU) was applied in SE in Groups 1 and 3, while dentin surfaces were conditioned with an Er, Cr:YSGG laser (1.5 W, 20 Hz) before adhesive application in Groups 2 and 4. The nanohybrid composite (Filtek Z550—FZU) was placed and light-cured. SBS was determined with a universal testing machine, while fracture patterns were evaluated under a stereomicroscope, and the results were statistically assessed by either ANOVA or the Kruskal–Wallis test (p 0.05). Evaluation of failure types revealed no difference in failure type distribution between SE and LE groups (p > 0.05). Conclusion: Dentin depth and etching technique had no effect on the SBS of composite resin. No difference was found between groups in terms of failure types

The impact of the COVID-19 pandemic on scientific publications in the field of hernia surgery: a brief bibliometric analysis

Purpose: The aim of this study is to evaluate the impact of COVID-19 pandemic to the publication activity in herniology. Methods: A PubMed search was used to perform a comprehensive search of the scientific literature each year between 2010 and 2024 by using key words as “inguinal hernia,”“umbilical hernia,” “incisional hernia,” “laparoscopic inguinal hernia,” “laparoscopic incisional hernia,” “robotic inguinal hernia,” and “robotic ventral hernia.” The analysis was done both annually and across three consecutive 5-year intervals: 2010–2014 [Period A], 2015–2019 [Period B], and 2020–2024 [Period C]. Period C, which corresponds to the era of the COVID-19 pandemic, was also searched for the publications about inguinal and ventral hernias which were related to the COVID-19 pandemic. Results: A total of more than 40,000 hernia-related publications were identified between 2010 and 2024. Publication activity demonstrated an overall upward trajectory, with notable shifts in thematic focus over time. The most frequently retrieved keywords were inguinal hernia, hernia mesh, and incisional hernia. Publications on inguinal hernia increased from 3,172 in 2010 to 4,525 in 2020, representing a 1.43-fold increase. Similarly, hernia mesh publications rose from 2,847 to 4,410 (1.55-fold), and incisional hernia publications nearly doubled from 1,187 to 2,336 (1.97-fold). Topics related to minimally invasive and robotic techniques exhibited the most pronounced fold increases. During the pandemic, publication activity in hernia research continued to grow up to 2021 but experienced a temporary slowdown between 2021 and 2022. In negative binomial regression models adjusting only for calendar year, no statistically significant association was observed between the COVID-19 period and overall publication volume (IRR = 1.02, 95% CI [0.47, 2.15]). After adjustment for calendar year and publication topic, the COVID-19 period was associated with a modest but statistically significant increase in publication volume (IRR = 1.16, 95% CI [1.01, 1.33], p =.037). In addition, a significant positive secular trend was observed across years (IRR per year = 1.05, 95% CI [1.03, 1.06]). Conclusions: The COVID-19 pandemic did not lead to a dramatic reduction in the overall volume of publications. There was a slight slowdown in the number of papers in certain subjects of hernia surgery, however, in the post-pandemic period publication activity rapidly returned to its pre-pandemic trajectory