Testicular germ cell tumors (TGCTs) are the most common type of testicular cancer, with a particularly high incidence in the 15–45-year age category. Although highly treatable, resistance to therapy sometimes occurs, with devastating consequences for the patients. Additionally, the young age at diagnosis and the treatment itself pose a great threat to patients’ fertility. Despite extensive research concerning genetic and environmental risk factors, little is known about TGCT etiology. However, epigenetics has recently come into the spotlight as a major factor in TGCT initiation, progression, and even resistance to treatment. As such, recent studies have been focusing on epigenetic mechanisms, which have revealed their potential in the development of novel, non-invasive biomarkers. As the most studied epigenetic mechanism, DNA methylation was the first revelation in this particular field, and it continues to be a main target of investigations as research into its association with TGCT has contributed to a better understanding of this type of cancer and constantly reveals novel aspects that can be exploited through clinical applications. In addition to biomarker development, DNA methylation holds potential for developing novel treatments based on DNA methyltransferase inhibitors (DNMTis) and may even be of interest for fertility management in cancer survivors. This manuscript is structured as a literature review, which comprehensively explores the pivotal role of DNA methylation in the pathogenesis, progression, and treatment resistance of TGCTs.

Background: Burns represent a serious health problem, associated with multiple-organ failure, prolonged hospitalization, septic complications, and increased rate of mortality. The main aim of our study was to evaluate the levels of various circulating molecules in children with severe burns (more than 25% TBSA), in three different moments: 48 h, day 10, and day 21 post-burn. Materials and Methods: This study included 32 children with burns produced by flame, hot liquid, and electric arc and 21 controls. Serum plasminogen activator inhibitor-1 (PAI-1), α 1-acid glycoprotein (AGP), C-reactive protein (CRP), and platelet factor 4 (PF4) were detected using the Multiplex technique. Several parameters, such as fibrinogen, leucocyte count, thrombocyte count, triiodothyronine, thyroxine, and thyroid-stimulating hormone were also determined for each patient during hospitalization. Results: Significant statistical differences were obtained for CRP, AGP, and PF4 compared to the control group, in different moments of measurements. Negative correlations between CRP, AGP, and PF4 serum levels and burned body surface, and also the hospitalization period, were observed. Discussions: CRP levels increased in the first 10 days after burn trauma and then decreased after day 21. Serum PAI-1 levels were higher immediately after the burn and started decreasing only after day 10 post-burn. AGP had elevated levels 48 h after the burn, then decreased at 7–10 days afterwards, and once again increased levels after 21 days. PF4 serum levels increased after day 10 since the burning event. Conclusions: Serum CRP, AGP, PAI-1, and PF4 seem to be promising molecules in monitoring patients with a burn within the first 21 days.

Background: Romania allocates the lowest proportion of healthcare spending to outpatients in Europe, while inpatient expenditures account for a disproportionate share of the national health budget. This imbalance generates access barriers and unmet healthcare needs (UHNs). Furthermore, heavy reliance on general practitioners (GPs) predominantly for bureaucratic functions (referrals), coupled with a high rate of hospital self-initiated admissions suggest bypass behaviors indicating existing UHNs. Our objective is to identify access barriers and resulting UHNs in the patient group interviewed, focusing on care-seeking behaviors. Methods: This analytical, cross-sectional, multi-center, hospital-based study identifies barriers and UHNs among hospitalized patients. Data collection occurred between April and June 2024 in two Romanian hospitals, across three wards: Urology, Pneumology, Obstetrics-Gynecology. A stratified proportionate sampling strategy was implemented with consecutive convenience sampling. A 22-item questionnaire was administered by nurses. Sociodemographic (covariates) and barriers (explanatory variables) follow Andersen’s and Tanahashi’s models, focusing on contact and effective coverage. Dependent variables include GP visit frequency (contact coverage) and hospital admission modes (effective coverage). Negative binomial regression and univariate logistic models assess associations between dependent variables and predictors. Results: A total of 217 patients were eligible for final analysis, representing 12.5% of total ward admissions. Contact coverage: significant associations were observed between GP visits and both gender (predisposing) and presence of chronic diseases (need). Men had a 32% lower rate of visits [Exp(B) =0.68, 95% confidence interval (CI): 0.54–0.87, P=0.002], chronic patients exhibited a 51% higher rate [Exp(B) =1.51, 95% CI: 1.18–1.94, P=0.001]. Time constraints (accessibility) reduced by half the frequency of visits [Exp(B) =0.50, 95% CI: 0.31–0.82, P=0.005]. Reflecting acceptability, individuals who rely on pharmacists had a 39% lower rate [Exp(B) =0.61, 95% CI: 0.38–0.99, P=0.045], while patients seeking advice from family or friends had a 44% lower frequency of GP visits [Exp(B) =0.56, 95% CI: 0.34–0.92, P=0.02]. Effective coverage: chronic patients were more than twice as likely to be hospitalized via GP referral [odds ratio (OR) =2.23, 95% CI: 1.23–4.05, P=0.008]. Financial constraints (accessibility) act as deterrents for patient-initiated admissions; higher costs induce 68% lower odds of self-initiated admissions (OR =0.32, 95% CI: 0.12–0.85, P=0.02). GP visits for referrals decrease the odds of GP-referred hospital admissions (OR =0.38, 95% CI: 0.17–0.84, P=0.02). Conclusions: Barriers encompass accessibility and acceptability factors. While primary care (contact coverage) is hindered by time constraints, financial burdens are obstacles to hospital self-initiated admissions (effective coverage). Men, chronic patients, and those who bypass formal consultations seeking advice from pharmacists, family or friends are particularly susceptible to UHNs. Even GP consultations involving bureaucratic referrals effectively divert outpatients from becoming inpatients. Policies should transform primary care to ensure effective coverage and mitigate avoidable hospital admissions.