Search

Anti-programmed cell death protein-1 (PD-1) therapy has been relatively recently approved in a defined context by NICE in adults in the management of recurrent and metastatic head and neck squamous cell carcinomas (HNSCC). In this context, companion diagnostic programmed cell death ligand-1 (PD-L1) testing, previously established at our center for lung and bladder tumors, was undertaken in a few head and neck cancer cases. The scope of this study was to audit the relevant PD-L1 data and integrate the findings in our current clinical practice, with a view to promote improved routine laboratory biomarkers in HNSCC. Histopathology reports documenting tumor type, PD-L1 result and type of clone/assay were included in this study. Over a 5-year period, PD-L1 testing was undertaken in 199 cancer cases, including 3 with head and neck squamous carcinoma with low focal positive staining. Immunotherapy treatment in HNSCC demonstrates a discreet but still significant improvement in the overall survival of PD-L1 positive subjects.

Systolic pulmonary artery pressure (SPAP) and right heart adaptation in relation to pre-existing preload are often disregarded. To determine volume-related changes in the pulmonary-right ventricle (RV) unit and the preload dependence of its components, we analysed pulmonary haemodynamics and right ventricular performance, taking advantage of the plasma volume removal associated to haemodialysis (HD). Fifty-three stable patients on chronic HD with LVEF > 50% and without heart failure were recruited (mean age 63.0 ± 12.4 years; 31.2% women; hypertension in 89% and diabetes in 53%) and evaluated just before and after HD (mean ultrafiltration volume 2.4 ± 0.7 l). SPAP from both times were available in 39 patients. After HD, SPAP decreased (42.2 ± 12.6 to 33.7 ± 11.6 mmHg, p 40 mmHg) (OR 1.29 (1.07–1.56), p = 0.006). Rapid volemic changes may affect FTR grading, RV size and contractility, with RV longitudinal strain being less variable than conventional parameters. SPAP decreases after HD, and this reduction is related to age and greater diminution of the E/eʹ ratio.

Background Parkinson's disease (PD) is the second most common progressive neurodegenerative disease. In the advanced stages, the continuous delivery of levodopa (LD) as levodopa-carbidopa intestinal gel (LCIG) has demonstrated significant improvement of motor and nonmotor complications and improvement of the patients' quality of life (QoL). Despite the growing global experience with this treatment, anumber of unsolved practical issues remain, and currently, the data on the reasons that can lead to the discontinuation of LCIG are scarce. Objective In the present study, we aimed to analyze the causes that led to the discontinuation of LCIG therapy. Methods In this retrospective study, after 10 years of experience with LCIG as a therapeutic option in advanced PD, we analyzed the data of all dropout cases among the 204 patients that initiated LCIG therapy in two Romanian centers. Results Of the 204 patients enrolled, 43 patients dropped out. Disease duration until LCIG infusion was significantly longer (11.67±4.98 vs 9.44±3.44) and the overall clinical picture more sever (both regarding motor symptoms and cognitive decline) in dropout patients (compared to patients who continued treatment). The dropout patients also presented significant differences regarding the incidence of polyneuropathy (32.5% vs 11.18%). The main cause of discontinuation was death. Conclusion The causes of discontinuation from LCIG therapy in Romanian patients are similar to those from other centers; however, the rate of dropouts is somewhat lower. The clinician's experience in selecting and treating the patients in advanced stages of PD can increase therapeutic adherence. Also, the presence of a well-trained caregiver along with the availability of a proper aftercare system is mandatory for maintaining the long-term benefits of the therapy and the overall best outcome possible. Targeted prospective studies are needed to confirm whether a more severe stage of the disease and cognitive impairment at the time of initiation, respectively, the association of polyneuropathy can be considered as predictive factors for dropout.

(1) Background: Intralenticular tumors are an entity akin to Schrodinger’s cat since, although the human crystalline cells themselves are not known to malignly proliferate, various entities can take the appearance and clinical presentation of a tumor originating in the lens. We present the peculiar case of an 11-year-old male patient of African descent, HLA B27+, with a previous history of minor ocular trauma and unilateral anterior uveitis a year before which was admitted to our department with total opacification of the crystalline lens in the right eye and lens neovascularization. During surgery, a vascular, white fibrotic mass measuring 0.1–0.2 cm was discovered inside the lens bag and was excised. (2) Methods: Retrospective case review. (3) Results: The histopathological exam of the excised mass revealed an abundant infiltrate consisting of CD68+ foamy macrophages and lymphoplasmacytic elements. CD68 is a pan-macrophage marker associated with an active inflammatory mechanism soliciting macrophages, and tissue activated macrophages are correlated to increased stromal and serum levels of vascular endothelial growth factor, providing an explanation for lens angiogenesis. (4) Conclusions: The diagnosis is of a “masquerade tumor” resulted from an abnormal inflammatory process in connection with previous ocular trauma and possibly the patient’s HLA B27+ status.

Gastrointestinal stromal tumors (GISTs) are the most common malignant mesenchymal lesions of the gastrointestinal tract. They originate from the interstitial cells of Cajal and are characterized by overexpression of the tyrosine kinase receptor, protein product of c-KIT gene (KIT). In this retrospective study, conducted over a period of 10 years, we retrieved from our database, a total number of 57 patients, admitted and operated in the surgical department of 'Sf. Pantelimon' Emergency Clinical Hospital, Bucharest, for digestive tumors, histopathologically confirmed as GISTs. More than half of the cases presented as surgical emergencies and the tumors found during the surgical procedures, which proved to be GISTs, were sometimes difficult to differentiate from other mesenchymal tumors, both for the clinician and the pathologist. The diagnosis of GIST relies mostly on pathology and immunohistochemistry, but also on clinical and imagistic data. The most common emergencies were digestive hemorrhage (associated with gastric location), followed by intestinal obstruction (especially for the ileal localization). The largest dimensions corresponded to gastric location. For selected indications (upper digestive sites), upper digestive endoscopy approaches 100% sensitivity. This study focuses on diagnosis of GISTs sustained by both clinical and imagistic methods, along with histopathology and immunohistochemistry techniques, according to the World Health Organization 2019 criteria. Even though the differential diagnosis of these tumors is challenging, an interdisciplinary cooperation with a multiple approach increases the odds of a correct positive diagnosis.

Background There is insufficient data in the literature regarding the real-life, daily clinical practice evaluation of patients with advanced Parkinson's disease (APD). We are not sure what is the upper limit of dopaminergic medication, especially the levodopa (LD) dosage, and how it is influenced by access and suitability to the various add-on and device-aided therapies (DAT). Objective This retrospective study explored the profile of APD patients that were considered and systematically evaluated regarding the suitability for DAT. Methods We analyzed the data from 311 consecutive patients with APD hospitalized between 2011 and 2017 that 1) described at least 2 hrs/day off periods divided into at least two instances/day (except early morning akinesia), 2) were in stage 3 or above on the Hoehn and Yahr scale, 3) were with or without dyskinesia, and 4) received at least four levodopa doses/day combined with adjuvant therapy. Results Of the 311 patients enrolled initially, 286 patients showed up for the second visit, of which in 125 cases we assessed that DAT would be necessary. Finally, 107 patients were tested in our clinic to confirm the efficacy of LCIG. Patients selected for DAT had significantly longer off periods, more frequent dyskinesia, early morning akinesia, and freezing despite having significantly higher LD doses than those with an improved conservative therapy. Conclusion Patients with APD can have a variety of symptoms, and because symptoms and therapeutical efficacy can be manifested in many different combinations, it is not possible to decide using a single, rigid set of criteria which APD patient is eligible for DAT. Nevertheless, treating physicians should refer APD patients to a specialized movement disorder center when patients with an average daily dose of LD of at least 750-1000 mg and maximal complementary therapies present daily motor complications that significantly reduce the quality of life.

The World Health Organization (WHO) estimates that 170 million individuals worldwide are infected with hepatitis C virus (HCV). The aim of study was to evaluate possible correlations between METAVIR staging, the viral loads and alanine aminotransferase (ALT) levels in patients with chronic hepatitis C, before and after 12 weeks of treatment with PegInterferon a2a/a2b and Ribavirin. 93 consecutive patients with hepatitis C, were included in this study. The parameters followed were age, sex, Metavir histologic staging at the start of the treatment, hepatitis C virus ribonucleic acid (HCV-RNA) and ALT at start and after 12 weeks of treatment, as well as alcohol intake. The study group was composed by 58 women and 35 men, with a mean age of 44.47 � 11.17 years. At the beginning of the treatment, the mean value of HCV-RNA was 1327163 � 145001 UI/mL, with a CI95%=1327163 � 287986.36 UI/mL, and the mean value for ALT was 112.7124 � 68.7403 U/l. After 12 weeks of therapy, significant differences were found concerning both HCV-RNA and ALT values. HCV-RNA lowered to a mean value of 457.3978 � 402.653 (p[0.0001), while ALT lowered to a mean value of 37.90 � 16.43U/l (p[0.0001). Neither the initial HCV-RNA nor ALT values had any correlations with the METAVIR histological staging of the fibrosis. Initial ALT was higher in those with alcohol intake (p=0.000048). The ALT values instead, after 3 months of treatment, decreased significantly (p[0.0001), did correlate with the METAVIR groups (p=0.0019). The evolutionary stage of fibrosis didn�t correlate with gender of the patients or initial values of the HCV-RNA or ALT. There was no correlation between the age/gender of the patients and the determined METAVIR score.

Background: In the advanced stages of Parkinson’s disease (APD), complex forms of dyskinesia may severely impair the patient’s quality of life. Objective: In the present study, we aimed to analyze the evolution under LCIG therapy of the most important motor fluctuations and complex disabling dyskinesias, including diphasic dyskinesia. Methods: In this retrospective study, we analyzed the characteristics of patients with APD who had at least 30 min of diphasic dyskinesia (DID) in 3 consecutive days, were considered responders and were treated with LCIG in our clinic. Patients were evaluated before and after PEG and at 6, 12 and 18 months, when the changes in the therapy were recorded, and they completed a 7-point Global Patient Impression of Improvement (PGI-I) scale. Results: Forty patients fulfilled the inclusion criteria—out of which, 34 performed all visits. There was a substantial difference between the calculated and real LCIG (1232 ± 337 mg vs. 1823 ± 728 mg). The motor fluctuations and most dyskinesias improved significantly after starting LCIG, but an increasing number of patients needed longer daily administrations of LCIG (24 instead of 16 h). Conclusions: Patients with APD with complex dyskinesias must be tested in dedicated hospitals, and they need a special therapeutic approach. The properly adapted LCIG treatment regarding the dose and time of administration completed with well-selected add-on medication should offer improvement for patients who want to or can only choose this DAT vs. others.

Background and Aims Haemodynamic cardiac changes in haemodialysis are associated with adverse cardiovascular outcomes and and they are difficult to measure. Systolic pulmonary artery pressure (SPAP) and right heart adaptation in relation to pre-existing preload are often disregarded. To determine volume-related changes in the pulmonary-right ventricle (RV) unit and the preload-dependence of its components, we analysed pulmonary haemodynamics and right ventricular performance, taking advantage of the plasma volume removal associated to haemodialysis (HD). Methods and results Fifty-three stable patients on chronic HD with LVEF >50% and without heart failure were recruited (mean age 63.0±12.4 years; 31.2% women; hypertension in 89% and diabetes in 53%) and evaluated just before and after HD (mean ultrafiltration volume 2.4±0.7l). SPAP from both times were available in 39 patients. After HD, SPAP decreased (42.2±12.6 to 33.7±11.6 mmHg, p40 mmHg) (OR 1.29 (1.07–1.56), p=0.006). Conclusion Rapid volemic changes determined by rapid fluid removal during hemodialysis; may affect FTR grading, RV size and contractility, with RV longitudinal strain being less variable than conventional parameters. SPAP decreases after HD, and this reduction is related to age and greater diminution of the E/e′ ratio.

Background and Objective Anti-programmed cell death protein 1 (PDL-1) therapy has been relatively recently approved in a defined context by NICE in adults for the management of recurrent and metastatic head and neck squamous cell carcinomas (HNSCCs). In this context, companion diagnostic PDL-1 testing, previously established at our center for lung and bladder tumors, was undertaken as per NICE recommendations and clinical requests in a few head and neck cases. Methods Histopathology reports incorporating PDL-1 test results were identified (5-year period January 2014 to January 2020; including HNSCCs)) and analyzed for tumor type, clone, and test result. Results PDL-1 testing was undertaken in 199 cases, including 3 with HNSCC, with low focal positive staining in all 3 cases (1%, 1%, and 15%). Conclusions Immunotherapy treatment in HNSCC has demonstrated a small but statistically significant improved overall survival in some studies. The strength of correlation between PDL1 expression and response to immune-oncology agents in HNSCC has, however, been established to a lesser degree in recent studies as opposed to some other tumor types, such as in lung carcinoma. This study aims to record data as per NICE recommendations and share them with a view to highlighting the case for improved routine laboratory biomarkers in HNSCC.

Background Ambrisentan is a selective endothelin receptor antagonist used for the treatment of pulmonary arterial hypertension (PAH). Little is known about ambrisentan removal by hemodialysis in patients with end-stage renal disease (ESRD). Case presentation A 53-year-old woman with HIV/hepatitis C virus (HCV) co-infection, PAH and ESRD on regular hemodialyis was admitted in our hospital due to refractory heart failure while on treatment with bosentan (125 mg twice daily) and tadalafil (20 mg once daily) for PAH and antiretroviral treatment (cART) including darunavir/cobicistat (800/150 mg once daily). Excessive exposure to bosentan due to drug interactions between bosentan and darunavir/cobicistat was suspected. Bosentan was replaced by ambrisentan, with progressive improvement in her clinical condition. Pre- and postdialyzer cocentrations of ambrisentan in plasma were determined and hemodialysis extraction ratio for ambrisentan was 2%. Conclusions Our results suggest that hemodialysis results in minimal ambrisentan removal, and therefore no specific ambrisentan dosage adjustment seems to be required in ESRD patients undergoing hemodialysis.

Background The aim of the study was to assess the awareness of colorectal cancer (CRC) patients about CRC screening methods and to investigate the relationship between awareness, socio-demographic characteristics and the stage in which patients with CRC are diagnosed. Methods The observational cross-sectional study included 275 CRC patients admitted between 2014 and 2016 to two surgical clinics from Tîrgu Mureş, Romania. Study variables were collected via face-to-face interview and from patients’ observation sheets. Results Only 41.5% of the patients heard about cancer screening and 6.5% about specific CRC screening methods. Mass-media was the major source of information (85.1%) followed to a much lesser extent (14.9%) by family, friends, and colleagues. Health professionals did not contribute at all to informing patients about screening methods. Awareness about screening methods was statistically associated with the patients’ residence, age, and educational achievement, but not with the stage of CRC. Conclusion The level of awareness of CRC screening methods was very low among the CRC patients included in the study but it could not predict the stage in which malignancy was diagnosed, suggesting that awareness alone is not enough to bring patients to undergo early CDC screening procedures.

Chronic hepatitis C (CHC) is a leading cause of liver disease. Despite the improved efficacy of new antivirals, their high costs preclude their adoption in resource-limited settings, where CHC prevalence is highest. We developed a triplex high-resolution melting assay for the simultaneous assessment of three genetic polymorphisms related to the response to treatment and development of advanced fibrosis in CHC: IFNL3 rs12979860, ABCB11 rs2287622, and RNF7 rs16851720. We validated the assay in clinical samples from 130 CHC patients treated with classic therapy. The assay showed excellent reproducibility and 100% accuracy, sensitivity, and specificity against the gold standard Sanger sequencing. When added to routine examination data, genotype information significantly improved their performance for prediction of advanced liver fibrosis and sustained virological response (P = 0.041 and P = 0.011, respectively). Correspondingly, the full models had area under the receiver operating characteristic curve values of 0.842 (95% CI, 0.773-0.911) and 0.921 (95% CI, 0.870-0.972) and integrated discrimination improvements of 7.5% (95% CI, 2.5%-12.5%; P = 0.003) and 11.5% (95% CI, 5.8%-17.2%; P 0.001), respectively. This is the first report on a diagnostic test for simultaneous genotyping of IFNL3, ABCB11, and RNF7 in CHC patients. Reliable and inexpensive, the assay should provide useful information for the clinical management of CHC, like identification of patients at risk of rapid disease progression or with high chances of response to classic therapy.

Introduction and objectives: PSA has been a useful tool in identifying prostate cancer since its discovery. However relying on this alone can lead to unnecessary over investigation as it can be falsely raised in other conditions. PSA density is a possible enhanced marker for prostate biopsy indication, however it is not standard practice or recommended in national guidelines. Previous studies have shown that PSA density is most useful when the PSA is in the range of 4-10. We aim to study the effectiveness of PSA density at detecting prostate cancer within that range as well as outside that range. Methods: Retrospective single centre study at Peterborough City Hospital including 500 patients who had a MRI prior to prostate biopsy between July 2017 to July 2018. Patients undergoing repeat biopsy already on a cancer pathway were excluded. PSA density was calculated by dividing PSA from the prostate volume recorded on the MRI. A cut of value of PSA density was chosen at 0.15 and 0.10. Results: Data from 500 patients with a mean age of 65 and mean PSA of 10.7 (PSA range 0.32 to 99). 251 (50.2%) patients had cancer on histology with 152 having clinically significant cancer. Mean PSA density was 0.11ng/ml/cm3 with benign histology, 0.36ng/ml/cm3 for all cancer and 0.48ng/ml/cm3 for clinically significant cancer. Overall the mean PSA density in prostate cancer was found to be 0.15. Sensitivity of PSAD at detecting all prostate cancer at cutoff of 0.10 with PSA 4-10 was 76% and 88% for clinically significant prostate cancer (Gleason 7>). The negative predictive value was 94% for clinically significant prostate cancer. With PSA of 10 and PSA density of 0.10 the sensitivity was 93% (all cancer) and 96.6% (Gleason 7>) with a negative predictive value of 93.7% for clinically significant prostate cancer. At a cut off PSA density of 0.15 sensitivity and negative predictive value was 39% and 65% (all prostate cancer) and 50% and 87% (Gleason 7 and above) respectively with PSA of 4-10. ROC curves were created for each PSA range comparing cancer cases versus benign to determine area under curve values. No statistically significant difference was found for PSA range 10ng/ml for all cancer vs benign. However, there was a statistically significant difference when comparing AUC for PSAD in the PSA range of 4-10ng/ml for all cancer vs benign. (p < 0.01). Conclusions: This study is useful as a high powered study with a large study population which shows a direct correlation of PSAD to Gleason scoring. PSAD cut off value of 0.10ng/ml/cm3 has a higher sensitivity and negative predictive value especially when compared against clinically significant prostate cancer. When the PSAD cut off value is increased, sensitivity decreases, however specificity improves. PSAD can be used to avoid unnecessary biopsies however also runs the risk of missing clinically significant cancers.

Altres ajuts: This work was supported by the project, integrated in the National R + D + I and funded by the ISCIII and the European Regional Development Fund (http://www.isciii.es). Also by the "Suport Grups de Recerca" programme of Secretaria d'Universitats i Recerca, Dept. Empresa i Coneixement, Generalitat de Catalunya , Group REMAR, http://agaur.gencat.cat), the Instituto de Salud Carlos III-Red de Investigación Renal (REDinREN) (Feder Funds, http://www.isciii.es, http://redinren.org), and Fundació Cellex. FEB is sponsored by the "Researchers Stabilization Program" from the Spanish "Sistema Nacional de Salud" (SNS- ISCIII, http://www.isciii.es) and "Direcció d'Estratègia i Coordinació" Catalan Health Department (CES07/015). Kidney transplantation (KTx) is the best therapeutic approach for chronic kidney diseases leading to irreversible kidney failure. Considering the origin of the graft, several studies have reported differences between living (LD) and deceased donors (DD) in graft and patient survival. These differences seem to be related to multiple factors including, donor age and time of cold ischemia among others. Many of transplanted organs come from old-aged DDs, in which pre-transplant biopsy is recommended. However, kidney biopsy has several limitations, and there is a need to develop alternatives to assess the status of a kidney before transplantation. As the analysis of urinary extracellular vesicles (uEVs) rendered promising results as non-invasive biomarkers of kidney-related pathologies, this pilot study aimed to investigate whether profiling uEVs of LDs and DDs may be of help to assess the quality of the kidney before nephrectomy. uEVs from 5 living donors and 7 deceased donors were isolated by size-exclusion chromatography, and their protein and miRNA content were analysed by liquid chromatography followed by mass spectrometry and next generation sequencing, respectively. Then, hierarchical clustering and venn diagrams were done with Perseus software and InteractiVenn tool. Specific EVs data bases were also used for Gene Ontology analysis. Next generation sequencing revealed that uEVs from DDs contained less miRNAs than LDs, but most of the DD-expressed miRNAs were shared with LDs (96%). Only miR-326 (targeting the apoptotic-related Bcl2) was found significantly over-represented in LD. Focusing on the protein content, we detected a low intra-group correlation in both types of donors. Despite these differences, hierarchical clustering of either miRNA or protein data could not identify a differential profile between LDs and DDs. Of note, 90% of transplanted patients had a functional graft after a year from KTx. In this pilot study we found that, in normo-functional grafts, minor differences in uEVs profile could not discriminate between LDs and DDs.

Anastomotic leaks (AL) still represent a major possibly life-threatening complication after colorectal surgery. The clinical presentation varies from mild symptoms to peritonitis and sepsis, which toughens the early diagnosis even for experienced surgeons. Numerous risk factors have been identified in the development of AL. The presence of bacterial strains such as Pseudomonas aeruginosa or Enterococcus faecalis are associated with higher AL rates, thus antibiotic prophylaxis seems to reduce complications. Male gender, advanced age, higher ASA fitness score, malnutrition and personal history of radiotherapy, diabetes mellitus and chronic kidney disease also lead to higher AL rates. The localization of the tumor also represents an important risk factor, as distal tumors have been identified as a predictor for AL. No differences have been found between open versus laparoscopic surgery as well as hand-sewn versus stapled anastomoses. The timing of the operation and the experience of the operating teams also affects both short and long-term. Early identification of AL is the key to reduction of mortality rates, thus scoring systems such as the Dutch Leakage Score have been developed and validated to aid surgeons for timely diagnosis. Modern imaging techniques and laboratory biomarkers further shorten the delay to a proper and early diagnosis. Computed tomography can identify even subclinical AL, leading to improved outcomes. Laboratory biomarkers such as C-reactive protein and procalcitonin are validated by large randomized studies as useful tools for exclusion of AL, possessing high negative predictive values.

Introduction. Renal disease plays an important role in the prognosis and evolution of chronic liver disease, in particular in its advanced stages. The aim of our study is to analyze the prevalence of chronic liver disease (hepatitis and cirrhosis of different etiologies) and to assess possible correlations between these and impaired renal function. Material and methods. We conducted a retrospective observational study based on data collected from observation charts of patients admitted to the 2nd Medical Clinic, Emergency County Hospital Tirgu-Mures between January 1st 2012-December 31 2013. In this study we included, based on informed consent, 401 patients with documented liver pathology, with preserved or modified renal function. Results. Age distribution shows that 41.1% of cases occured between 51 and 60 years of age. Sex distribution shows that 65.3% of cases were male. Toxic cirrhosis was found in 40.8% of males and viral C cirrhosis in 15.1% of women. Toxic cirrhosis associated the following complications: ascites (35.7%), encephalopathy (75%), PAH (68.6%), esophageal varices and upper GI bleed (35.7%). Analyzing the risk factors of renal failure we found that increased mean values of creatinine are associated with viral B cirrhosis (p = 0.02), portal vein diameter (OR 1.37), portal hypertension (OR 1.24), male gender (OR 1.84) and the age group 61-70 yo (OR 1.04). Conclusions. The current study demonstrated that renal function in chronic liver disease correlates with viral etiology of liver disease, its advanced stage, presence of portal hypertension, older age and male gender.

International audience; Chronic hepatitis C (CHC) is a major burden for public health worldwide. Although newer direct-acting antivirals show good efficacy, their cost precludes their wide adoption in resource-limited regions. Thus, strategies are being developed to help identify patients with high susceptibility to response to classic PEG-interferon + ribavirin therapy. IL28B polymorphism rs12979860 C/T is an important predictor for an efficient response to interferon-based therapy. A genetic variant in adiponutrin (PNPLA3) gene, rs738409 C/G, is associated with steatosis, severity, and progression of liver fibrosis in CHC patients, and predicts treatment outcome in difficult-to-cure HCV-infected patients with advanced fibrosis. We developed a rapid and inexpensive assay based on duplex high-resolution melting (HRM) for the simultaneous genotyping of these two polymorphisms. The assay validation was performed on synthetic DNA templates and 132 clinical samples from CHC patients. When compared with allele-specific PCR and sequencing, our assay showed 100% (95% CI: 0.9724-1) accuracy, with 100% sensitivity and specificity. Our assay was robust against concentration and quality of DNA samples, melting curve normalization intervals, HRM analysis algorithm, and sequence variations near the targeted SNPs (single nucleotide polymorphism). This duplex assay should provide useful information for patient-oriented management and clinical decision-making in CHC.

Starting with a case report, we made a detailed review of the literature, with the purpose of identifying and analyzing the type of iatrogenic vascular lesion following knee arthroscopy and the method of vascular repair. A PubMed literature search was undertaken to locate all reported cases of major vascular iatrogenic injuries during arthroscopic knee procedures. We identified 39 papers which report a total of 62 cases of major iatrogenic popliteal lesions after knee arthroscopy, between 1985 and 2014. The type of arthroscopic intervention performed, the type of iatrogenic vascular lesion encountered, the time passed until its discovery and treatment, the method of vascular reconstruction, and the postoperative course are presented. Postarthroscopy vascular complications are infrequent but potentially disastrous for the condition of the affected inferior limb. An early diagnosis and reintervention are mandatory for a good postoperative outcome.

Background Some lesions not included in the Banff classification, such as inflammation in the scarred areas and total inflammation, have been described to have prognostic value in the evaluation of graft biopsies. Our aim was to reassess kidney graft biopsies and study the impact of histopathologic lesions, both those graded in the Banff classification and those related to inflammation, on the graft function and evolution. Methods We selected 20 biopsies exhibiting chronic pathology without a specific phenotype, and we reevaluated them with the use of a modified Banff score. Results We found statistically significant association between the presence of total inflammation (P = .048; P = .038), the presence of inflammation in scared area (P = .037; P = .018), and creatinine at the time of renal biopsy and 1 year after the renal biopsy, respectively. Conclusions Our results suggest that the presence of both inflammation in the scarred areas and total inflammation are related to renal function at the time of the biopsy and to renal function 1 year after the biopsy.

Introduction. Labeling a patient as “frail” may be useful in assessing the prognosis and therapeutic approach. Objective. The aim of the study is to define a pattern of frailty among our dialysis population, to analyse the incidence and clinical evolution of these patients. Materials and Methods. We analysed a total of 320 patients with stage V chronic kidney disease (CKD) who were on hemodialysis between September 2014 and September 2015. To define a patient as frail we used the Fried phenotype model, and we added a new criteria-dialysis session length longer than 12 hours/week. Results. 5.6% of the 320 patients were frail. We found statistically significant differences regarding body mass index (BMI), hemoglobin (Hgb), and serum albumin, as well as the ability to perform the basic activities of daily living (p<0.005), ability to ambulate (p=0.01) and perform transfers (p<0.005). We found statistically significant differences between the two groups in terms of hospital admissions (p=0.005) and mortality (p<0.005). Conclusion. 5.6% of the study population were frail, with lower BMI, serum albumin and hemoglobin, lower capacity for basic activities of daily living, ambulation, and transference, as well as higher morbidity and mortality.

Laparoscopic sleeve gastrectomy (LSG) has gained ground in Eastern Europe in the decade but fewer reports of large series with medium-term follow-up exist. We describe a single-surgeon experience in LSG (the first 101 consecutive cases) in a Balkan emerging bariatric center. A prospectively maintained database of the initial 101 consecutive patients submitted to LSG in our clinic between October 2010 and February 2016 was reviewed. The percentages of mean excess weight loss (%EWL) in the 101 patients (mean age of 42 ± 10.6 years, 77 % female, median preoperative body mass index (BMI) of 44.5 kg/m2) were 51.3 (n = 82 followed-up patients) at 6 months postoperatively, 78.2 (n = 69) at 1 year, and 75.8 (n = 39), 77.1 (n = 20), 67.5 (n = 17), and 52.9 (n = 7) at 2, 3, 4, and 5 years, respectively. One year after LSG, all comorbidities showed remission or significant improvement in all 69 followed-up patients; the highest resolution was seen with hypertension (73.3 %). We noted a negative correlation between a decrease in %EWL and both the age of the patient and the initial state weight and BMI. The mortality in our group was nil; we had three cases (2.9 %) of bleeding and no leaks. LSG is a safe procedure, with low postoperative morbidity rates and excellent short-term %EWL results up to 3 years after surgery, including resolution or improvement of the main obesity-related comorbidities. The results were superior in the category of younger and lower initial BMI obese patients.

INTRODUCTION: IGF-1 (insulin-like growth factor-1) is a hormone involved in cell growth and other important processes. In the kidney, IGF-1 has a stimulating effect, increasing the blood flow and glomerular filtration rate. Although many experimental animal studies regarding the role of IGF-1 in the kidney have been conducted, few human studies are available in the literature. Obesity is a cause of renal failure, and several glomerular lesions associated with obesity have been described. However, no studies regarding the levels of IGF-1 in morbidly obese patients with renal injury associated with obesity have been conducted. AIM: To determine the serum IGF-1 concentrations in morbidly obese patients with normal renal function but with different types of early obesity-related glomerular lesions and to evaluate the possible relationship between IGF-1 and the presence of renal lesions. METHODS: Eighty morbidly obese patients with renal biopsy, including 11 patients with no evidence of renal lesion, 17 patients with single glomerulomegaly, 21 patients with single podocyte hypertrophy, 10 patients with glomerulomegaly and podocyte hypertrophy, 5 patients with focal segmental hyalinosis, and 16 patients with increased mesangial matrix and/or mesangial proliferation, participated in this study. Biological parameters, including serum IGF-1 concentrations with the standard deviation score for age (SDS-IGF-1), were determined for all patients. RESULTS: Eighty patients (50 women and 30 men) with a mean BMI of 52.63 ± 8.71 and a mean age of 42.40 ± 9.45 years were included in this study. IGF-1, IGF-1 SDS and IGF-1BP3 levels according to the renal injury were compared (normal glomeruli: IGF-1 = 190.17 ± 72.46; glomerulomegaly: IGF-1 = 122.3 ± 50.05; podocyte hypertrophy: IGF-1 = 119.81 ± 60.34; focal segmental hyalinosis: IGF-1 170.98 ± 100.83, increased mesangial matrix and/or mesangial proliferation: IGF-1 117.73 ± 63.87). Statistically significant differences were observed between serum levels of IGF-1 and between the levels of SDS-IGF-1 by comparing the group without glomerular lesion with the group formed by patients with any type of glomerular injury. Logistic regression analysis was performed, with the dependent variable defined as the glomerular injury. In the multivariate analysis, only SDS-IGF-1 was associated with glomerular injury, and low levels of IGF-1 SDS were a risk factor for kidney injury. CONCLUSIONS: Our study demonstrates that low IGF-1 serum levels are associated with renal lesions in morbidly obese patients without overt clinical renal manifestations

Patients with chronic kidney disease (CKD) are characterized by a state of inflammation and oxidative stress that seems to improve after kidney transplantation (KT). Nevertheless, there is controversy regarding what is the best marker that better define inflammation and specially oxidative stress. To evaluate the biomarkers which are associated with improvements in inflammation and lipid peroxidation in patients who have undergone KT. To evaluate the relationship between inflammation, lipid peroxidation and mortality in KT. 196 KT (between 2003 and 2008). 67.9% men; median age: 51.9 years. Inflammation markers analyzed previous KT and 3 months after KT: c-reactive protein(CRP), interleukin 6(IL-6), tumor necrosis factor alpha(TNF alpha), soluble tumor necrosis factor receptor alpha(sTNFR alpha), soluble interleukin-2 receptor (sIL-2R). Lipid peroxidation markers analyzed: oxidized low-density lipoprotein (oxLDL) and anti-oxLDL antibodies. Calculation of glomerular filtration rate after KT: MDRD equation. Following KT, there is a significant decrease in CRP (p = 0.006), IL-6 (p = 0.0037), TNF alpha (p < 0.0001), sTNFR alpha (p < 0.0001) and sIL-2R (p < 0.0001), while levels of oxLDL increase after KT (p < 0.0001) and there is not a significantly difference in anti-oxLDL. 12.8% of the patients had died in 2012. These patients had higher levels of IL-6 (p = 0.011) and sTNFR alpha (p < 0.006) after KT and a lower MDRD (p < 0.0001), hemoglobin (p = 0.012) and albumin (p = 0.007). We observed no statistically differences in the levels of markers previous KT. Of the patients who died, the 43.5% of them had anti-oxLDL antibody levels greater than 75th percentile (P-75: 3781 UI/ml, p = 0.028). In the multivariate analysis, age (OR:1.12; p = 0.0129), MDRD (OR:0.92; p = 0.013) and P-75 of anti-oxLDL(OR: 5.19; p = 0.026) were independent risk factors for mortality. Independent risk factors for survival were: P-75 of IL-6 (HR: 2.45; p = 0.027), oxLDL (HR:19.85; p = 0.002) and anti-oxLDL (HR: 9.55; p = 0.003). KT improved inflammation but not lipid oxidative state. KT patients who died had a higher inflammatory state (with higher levels of IL-6 and sTNFR alpha), a worse lipid oxidative state and a worse renal function 3 months after KT. Age, anti-oxLDL and renal function at 3 months after KT were independent risk factors for mortality.

Data on dolutegravir removal by hemodialysis are lacking. To study this, we measured dolutegravir plasma concentrations in samples of blood entering and leaving the dialyzer and of the resulting dialysate from 5 HIV-infected patients with end-stage renal disease. The median dolutegravir hemodialysis extraction ratio was 7%. The dolutegravir concentrations after the dialysis session remained far above the protein-binding-adjusted inhibitory concentration. Our results show minimal dolutegravir removal by hemodialysis, with no specific dolutegravir dosage adjustments required in this setting. (This study is registered at ClinicalTrials.gov under registration number NCT02487706.)

Absztrakt A laparotomiák egyik késői szövődménye a posztoperatív hasfali sérv. A hegsérvek feszülő varratokkal való rekonstrukciója után gyakran alakul ki recidiva. A szövetbarát műanyag hálók beültetésével, azaz feszülésmentes technikával lényegesen jobb eredmények érhetők el. Klinikánkon 2001 és 2005 között a medián vonalban kialakult, nagy hasfali sérvek rekonstrukcióját 50 esetben retromuscularis pozicióba helyezett műanyag hálóval végeztük. A háló okozta szövődmények megelőzése céljából a hálót a sérvtömlőt képező peritoneum felhasználásával úgy a hasüreg, mint a sub-cutis felé is fedtük. Műtét után egy esetben az a. epigastrica inferior sérülésére visszavezethető haematoma alakult ki. A többi betegünk szövődménymentesen gyógyult. A feszülő varratokkal végzett sérvműtétekkel összehasonlítva lényeges eredménynek tartjuk a posztoperativ fájdalom enyheségét és a betegek korai mobilizálhatóságát. Következtetés: a rectus-hüvelybe helyezett és sérvtömlővel fedett műanyag háló egy alternatíva a nagy, medián hasfali defektusok rekonstrukciójában és a háló okozta szövődmények kivédésében.

Background Post-transplant recurrent glomerulonephritis (RGN) is the third cause of graft failure in the first year after renal transplantation (RT). The purpose of this study was to analyze the incidence of RGN, clinical presentation, and clinical evolution of transplanted renal graft in patients who underwent RT at our center. Methods We studied patients with glomerulonephritis (GN) who underwent RT (2007 to 2013).We analyzed sex, age, time in dialysis, type of GN, type of RT, time to post-transplant RGN, kidney function at the time of diagnosis of RGN, and renal graft evolution. Renal biopsy samples were processed in the anatomic pathology laboratory. Results Three hundred sixteen patients received kidney transplantation during this time period. In 83 cases, the reason for transplantation was primary GN. Of these 83 patients, 15 (18%) had RGN confirmed by renal biopsy. Data for these 15 patients include sex: 73.3% men, 26.7% women; mean age: 42.2 (29–73) years; type of RT: 80% cadaveric donor (CD) versus 20% living donor (LD); type of GN: 18.4% immunoglobulin (Ig)A nephropathy, 35.7% membranous GN, 10.53% type I membrano-proliferative GN (MPGN I), and 16.6% focal segmental glomerular sclerosis (FSGS). The mean time to post-transplant RGN was 2 years (1 month to 16 years). Patients who received an LD transplant had a shorter time to post-transplant RGN than those who had a CD transplant. One patient with FSGS and one with MPGN I had a time to post-transplant RGN of less than 1 year. In the evolution of renal function, 33.3% of patients had graft failure. Conclusions The incidence of RGN was lower (18%) than that published in the literature. Membranous nephropathy was the most frequent cause of post-transplant RGN. Patients who underwent LD transplantation and those with IgA nephropathy had a shorter interval of time to post-transplant RGN than patients with FSGS and MPGN I.

Background Historically, alongside regulatory and jurisdictional differences in scope of practices, practice patterns of naturopathic doctors (NDs) have varied widely to promote holistic or whole-person treatment using a variety of therapies including: controlled substances, minor surgery, a variety of complementary therapies, as well as both novel and conventional assessments. However, little is known about the observed practice patterns of NDs, the services provided to their patients, or the type of conditions for which patients of NDs are seeking treatment. In order to address this gap, a cross-sectional descriptive analysis of the largest Canadian teaching clinic for NDs was undertaken to better understand the services provided to the community and increase the knowledge regarding the use of naturopathic medicine. Methods Data stemmed from two sources at the Toronto, Ontario clinic: a passive patient satisfaction survey, and the clinic’s point-of-sale (POS) system. Data included patient demographics, postal codes, health services utilization, ICD-10 codes, therapies employed, along with other data relating to the financial transactions associated with the visit. Simple descriptive statistics and the Kruskal-Wallis test were used to compare different age-based groups and examine health services use between years. This study was approved by the Research Ethics Board of the Canadian College of Naturopathic Medicine. Results 13,412 patients were treated in 76,386 patient visits spanning three clinic years. Median age of patients was 37; females outnumbered males (2.6:1) in all age-based groups except the pediatric population. In the patient satisfaction survey, there were 1552 potential survey respondents; with 118 responses received (response rate: 7.6%). Obtaining health education, health prevention and help with chronic health conditions were the primary motivators for patient visits identified in the patient survey. Conclusion The clinic attracts people from a wide area in the metropolitan Toronto and surrounding region with health concerns and diagnoses that are consistent with primary care, providing health education and addressing acute and chronic health conditions. Further explorations into health services delivery from the broader naturopathic or other complementary/alternative medical professions would provide greater context to these findings and expand understanding of the patients and type of care being provided by these health professionals. Electronic supplementary material The online version of this article (doi:10.1186/s12906-015-0550-6) contains supplementary material, which is available to authorized users.

Aims: No long-term studies of renal function evolution in morbidly obese (MO) patients after weight loss are available. The aim of our work was to ascertain the long-term influence of drastic weight reduction on renal function in MO patients with obesity-related glomerular lesions. Methods: 92 MO patients with normal renal function and biopsy evidence of mild obesity-related glomerulopathy underwent bariatric surgery (BS) and subsequent drastic weight loss. A long-term prospective follow-up (mean duration: 76 ± 42 months) was carried out. Basal renal biopsies and basal and long-term metabolic and renal function studies were performed in all cases. Linear mixed models were applied. Results: Blood pressure dropped early after BS and remained stable thereafter. Creatinine clearance and BMI fell in the first 2 years, rose slightly after 5 years and then remained stable. Serum creatinine and albuminuria decreased throughout the follow-up period. Renal function and albuminuria evolution showed non-significant differences in relation to the number of glomerular lesions. Conclusions: Drastic weight loss in BS-treated MO patients with pre-surgical normal renal function and mild obesity-related glomerular lesions is associated with short- and long-term maintenance of normal renal function and improvement in both arterial hypertension and albuminuria.

Background: The present study proposes to analyze the results obtained after transhiatal esophagectomies (THE), from the perspective of an Eastern European surgical center with low esophageal resection volume (LV). Aims: Our analysis, which to the authors’ knowledge is the first of its kind in Romania, has the purpose of comparing our results with those obtained in higher or similar volume centers, in order to derive conclusions regarding the quality of therapeutic management for patients diagnosed with esophageal cancer in Romania. Study Design: Retrospective observational study. Methods: In total, 70 patients were included, in whom THE was performed during the period 1997-2013 by six senior surgeons. The majority of our patients had esophageal cancers (n=66; 94.3%); we also performed 4 THE procedures for benign conditions (n=3; 4.27%) and esophageal perforation (n=1; 1.42%). Results: The majority of cancer-group patients had T3/N+ tumors. The nodal involvement in the T2, T3 and T4 categories was 9.9%, 21.6% and 35.1%, respectively. Complications were identified in 45 patients (68.2%), with the majority being represented by pulmonary complications (16 patients; 24.3%) and cervical leaks (15 cases; 22.7%). In-hospital mortality was 9.09%. We found a one-year overall survival rate of 58.7% (95%CI: 51.7-65.7%), 27.2% at 2 years (95%CI: 21.2-36.2%) and 10.5% at 3 years (95%CI: 6.5-14.5%). The median survival rate was estimated to be 16 months. Conclusion: Morbidity and in-hospital mortality after THE was performed in low-volume centers, despite being significantly higher than reported in HV centers, could be kept at reasonable rates. In our opinion, the measures which have the potential to raise the standard of care for patients diagnosed with esophageal cancer in Romania are represented by the standardization of therapeutic and diagnostic protocols for esophageal cancer and the centralization of these major oncologic interventions in surgical excellence centers.

Primary hyperparathyroidism (pHPT) is a common disease, in the majority of cases determined by a single solitary parathyroid adenoma; it is more frequently encountered among older women, between 50-60 years. Due to advances in imaging, preoperative localization of the hyperfunctioning or enlarged gland is almost always possible. In this perspective the classic bilateral neck exploration shifted to limited (focused) surgical approaches i.e. minimally invasive parathyroidectomy (MIP). The aim of this study is to do a short literature review of MIP surgical techniques and to present the surgical procedure we have used, along with our initial experience, respectively.

Background There are few reports about the clinical course and prognosis of monoclonal gammopathy of undetermined significance (MGUS) in long-term immunosuppressed patients. Our aim was to study the association and evolution of MGUS and renal transplantation. Methods Subjects submitted to renal transplantation between 1996 and 2011 who presented MGUS before or after immunosuppressive treatment was established were selected. Results Patients (N = 587) underwent kidney transplantation in our center during the selected period. MGUS was detected in 17 (2.9%) patients (10 men and 7 women with a mean age of 69.9 ± 10.07 years), with a median follow-up of 6 years. All patients had a functioning graft. Nine had MGUS before transplantation. One patient had multiple myeloma, and 8 remained stable. Eight patients had development of MGUS after transplantation. Six patients remained stable, 1 showed no MGUS, and 1 displayed an increased monoclonal component in further controls. Conclusions In our study, renal transplantation is not a risk factor for the development of malignant processes in patients with MGUS before transplantation. There is a group of patients who tend to have MGUS after transplantation; nevertheless, they had a benign evolution during a 6-year follow-up.

Introduction: Coumadin and low molecular weight heparin (LMWH) induced skin necrosis are rare clinical conditions. Case presentation: A 63-years-old female patient, known with hypertension and right-sided hemiparesis, had presented to the emergency departement with pain and erythema of her internal right thigh. Venous Doppler-echography showed internal safenous vein thrombosis, thus she was started on anticoagulant treatment with Dalteparin and Acenocoumarol. On the 5th day of treatment she developed plantar hematoma on her left leg, followed by the appearance of hematomas, on the lower third of her right calf and on coxofemoral regions. Therefore, we raised the suspicion of heparin or coumadin-induced cutaneous necrosis, we stopped the anticoagulation for 5 days and restarted it with the administration of Rivaroxaban, fresh frozen plasma, antibiotics and local, sterile, saline dressings. After four days the patient presented deep vein thrombosis on her left calf. Results and Discussion: Coagulation abnormalities were suspected, but infirmed by normal values of specific laboratory tests, such as Protein C (472.2%), protein S (77.10%), lupus anticoagulant (LA1-screening 53, 5s, LA-confirmation 38,0s). Hemogram showed normal platelet values. To exclude a malignancy, abdominal CT scan was performed, which revealed a right adnexal inomogenic cystic lesion, CA-125 (6,5U/ml), requiring further gynecological investigations. For the treatment of skin lesions, the patient required necrectomy and skin graft application. Conclusion: Particularly, considering that the patient was initially anticoagulated with LMWH and coumadins simultaneously, the etiology of her cutaneous lesions remains uncertain.

A two-axis scanning catheter was developed for 3D endoscopic imaging with spectral domain optical coherence tomography (SD-OCT). The catheter incorporates a micro-mirror scanner implemented with microelectromechanical systems (MEMS) technology: the micro-mirror is mounted on a two-axis gimbal comprised of folded flexure hinges and is actuated by magnetic field. The scanner can run either statically in both axes or at the resonant frequency (= 350Hz) for the fast axis. The assembled catheter has an outer diameter of 2.8 mm and a rigid part of 12 mm in length. Its scanning range is +/- 20 in optical angle in both axes with low voltages (1 approximately 3V), resulting in a scannable length of approximately 1 mm at the surface in both axes, even with the small catheter size. The catheter was incorporated with a multi-functional SD-OCT system for 3D endoscopic imaging. Both intensity and polarization-sensitive images could be acquired simultaneously at 18.5K axial scans/s. In vivo 3D images of human fingertips and oral cavity tissue are presented as a demonstration.

Nephroureterectomy with perimeatal cystectomy is the gold standard for the treatment of urothelial upper urinary-tract carcinoma (UUTC). Ureteral endoscopic surgery has been proposed as a complementary step in nephroureterectomy, either open or laparoscopic, in order to obviate the low abdominal incision. Our goal was to establish the value of two techniques for endoscopic distal-ureteral management in one-step nephroureterectomy for UUTC.Between June 1995 and January 2006, 100 nephroureterectomies with an endoscopic distal ureteral approach were performed for UUTC (stage pT(a) in 31 cases, pT1 in 27 cases, pT2 in 21 cases, pT3 in 18 cases, and pT(4) in 3 cases). The tumor was pyelocaliceal in 65 cases, ureteral in 18 cases, and both ureteral and pyelocaliceal in 17 cases. Among the patients, 72 underwent "pluck" transurethral detachment of the intramural ureter, and 28 were managed by ureteral stripping. The follow-up was performed by cystoscopy with urinary cytology, ultrasonography, and intravenous urography. The mean follow-up was 44 months (range 4-129 months).All but two of the procedures were completed successfully. In these two patients, ureteral stripping failed, and open surgery was performed. The complication rate was 2.8% for the pluck technique and 7.1% for ureteral stripping. During follow-up, 23 patients had bladder recurrences, 2 had renal fossa tumors, 3 had secondary lymph-node invasion, 2 had contralateral UUTC, and 1 had asynchronous liver metastases. The disease-specific mortality rate was 12%.The endoscopic approach to the terminal ureter is safe and effective as part of one-step nephroureterectomy. Differences between the techniques with regard to operative time, complications, and oncologic outcome were not significant.

Objectives To evaluate lumbar spine and femoral neck bone mineral density (BMD) and T score at lumbar and femoral neck levels in documented coronary artery disease patients. Methods We studied spine and femoral neck bone mineral density in 68 angiographically documented coronary artery disease patients (narrowed main coronary vessels more than 50%) and 42 persons with normal angiography. Blood lipid profile was determined in all the participants. Both evaluated groups of patients were similar in age, sex and body mass index (BMI). All the received data were analyzed statistically. Results After final adjustment by age, sex and BMI, we found that severity of coronary artery disease independently correlated with Bone mineral density of femur and of lumbal spine. BMD was significantly lower in patients with coronary artery disease ( P = 0.04). Femur osteoporosis and osteopenia was found in 26,7 % of patients with coronary artery disease whereas only 12,3% of people with normal angiography had osteoporosis at the level of femur (P= 0.05, OR= 4.42; CI 95%, 1.29-14, 77). Lumbal spine osteoporosis and osteopenia was found in 27,5% and 11,8 % in people with normal angiography (P= 0.05, OR= 4.13; CI 95%, 1.18-12, 23). We also found a strong indirect correlation between total cholesterol and LDL cholesterol levels and bone mineral density at femoral levels (p Conclusions We can suppose that coronary artery disease and severity of atherosclerosis may serve as a bone turnover predictor. Thus, recommendation of Bone density measurement to patients with a coronary disease may be valuable for earlier diagnosis and prevention of osteoporosis and fractures. More studies are necessary to elucidate deeper the relationship between osteoporosis and coronary artery disease. Acknowledgements Department of Interventional Medicine, Institute of Cardiology of the Republic of Moldova Disclosure of Interest None Declared

Objective The literature data regarding sexual activity in patients with permanent urethral catheter is scarce. Our study aimed to evaluate the particularities of sexual habits in these patients. Design and method We evaluated the sexual activity of 321 male patients with long-term (more than 12 months) urethral catheter that were referred between January 1996 and June 2007 to our department for various urologic pathologies. All patients received a questionnaire in which were asked about the presence of any sex-related activity and were asked to describe it. All patients were also evaluated regarding the quality of life (QoL score). Results Only 304/321 patients (94.7%) chose to respond to our questionnaire. 211/304 patients (69.4%) reported no sexual activity during the period of urethral catheterization. 81/304 patients (26.7%) described some sexual-related activity but without any intercourse. 79 of these 81 patients had stable female partners. 12/304 patients (3.9%) reported sexual intercourse, all of them with stable female partners. Regarding sexual intercourse 10 of them had the urethral catheter removed temporarily and being catheterized by the female partner after the act. Two of these patients described sexual intercourses with the catheter. The sexual active patients had a mean QoL score with 1.2 points higher than those with no such activity. Conclusion The presence of sexual activity in patients with long-term urethral catheterization seems to improve the quality of life. This kind of sexual activity occurs usually in stable couples in which the female partner is indulgent and receptive to innovative solutions