About causes of early-stage asymptomatic prostate cancer

Central Military Hospital, The Republican Clinical Hospital, Institute of Oncology, Chisinau, the Republic of MoldovaBackground: The neurotransmitters (epinephrine and norepinephrine) of the sympathetic nervous system that perform numerous cellular and tissue functions contribute to tumor growth during the early stages of development. At the same time, these bioactive substances act as mediators of the descending antinociceptive system that cause inhibition of pain at the suprasegmental and segmental levels of the neurotransmission. Later studies point to the involvement of afferent sensory neurons in tumor process. The functionality of these structures can be changed due to the structural features caused by genetic disorders of myelin. In addition to that, tumor augmentation of sensory neurons endings leads to the involvement of myeloid-derived suppressor cells in the affected area and the creation of an immunosuppressive microenvironment. At the same time, in the secondary inflammatory process, various enzymes that change the cellular matrix and cause invasion and metastasis are released. In addition to sensitizing cytokines, immunocompetent cells – macrophages, neutrophils, lymphocytes – can also produce opioid peptides that target the desensitization of peripheral nociceptors. Opioid peptides inhibit the excitability of sensory nerves without central unwanted side effects such as depression of breathing, clouding of consciousness, or addiction. This peripheral antinociceptive system with ICC may allow the neoplasm to remain asymptomatic for a while. The changes in afferent impulses at the central level in oncopathology can also be associated with those in the functionality of Toll-like receptors. Conclusions: Taking into account the aforementioned literature data about oncogenesis, it may be assumed the presence of a new complex pathogenetic pattern that ensures the asymptomatic evolution of prostate cancer. A better coverage of this data may facilitate further search for early markers of the disease

Characteristics and hospital course of patients admitted for acute cardiovascular diseases during the coronavirus disease-19 outbreak

INTRODUCTION: During the coronavirus disease-19 (COVID-19) outbreak in spring 2020, people may have been reluctant to seek medical care fearing infection. We aimed to assess the number, characteristics and in-hospital course of patients admitted for acute cardiovascular diseases during the COVID-19 outbreak.METHODS: We enrolled all consecutive patients admitted urgently for acute myocardial infarction, heart failure or arrhythmias from 1 March to 31 May 2020 (outbreak period) and 2019 (control period). We evaluated the time from symptoms onset to presentation, clinical conditions at admission, length of hospitalization, in-hospital medical procedures and outcome. The combined primary end point included in-hospital death for cardiovascular causes, urgent heart transplant or discharge with a ventricular assist device.RESULTS: A similar number of admissions were observed in 2020 (N\u200a=\u200a210) compared with 2019 (N\u200a=\u200a207). Baseline characteristics of patients were also similar. In 2020, a significantly higher number of patients presented more than 6\u200ah after symptoms onset (57 versus 38%, P\u200a<\u200a0.001) and with signs of heart failure (33 versus 20%, P\u200a=\u200a0.018), required urgent surgery (13 versus 5%, P\u200a=\u200a0.004) and ventilatory support (26 versus 13%, P\u200a<\u200a0.001). Hospitalization duration was longer in 2020 (median 10 versus 8 days, P\u200a=\u200a0.03). The primary end point was met by 19 (9.0%) patients in 2020 versus 10 (4.8%) in 2019 (P\u200a=\u200a0.09).CONCLUSION: Despite the similar number and types of unplanned admissions for acute cardiac conditions during the 2020 COVID-19 outbreak compared with the same period in 2019, we observed a higher number of patients presenting late after symptoms onset as well as longer and more complicated clinical courses