Tricoronary atherosclerotic lesion identified incidentally in a patient with diabetes, clinical case

Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica MoldovaIntroducere. Boala coronariană (BC) se dezvoltă în 25% la pacienții cu diabet zaharat (DZ) și prezintă deces intraspitalicesc 4,8%, la 30 de zile (6,7%) și la 1 an (13,7%). Dislipidemia în DZ este asociată cu plăci aterosclerotice vulnerabile care evaluează cu sindroame coronariene acute (SCA) recurente silențioase. Scopul lucrării. Prezentăm cazul clinic a pacientei cu DZ, HTA cunoscută cu cardiopatie ischemică (CPI), angină pectorală (AP) silențioasă, care a fost depistată accidental cu stenoză aortică degenerativă și leziuni aterosclerotice tricoronariane. Material și metode. Femeie, 70 de ani internată cu AP și HTA gr.II. Hipertensivă de 20 ani, AP de 12 ani și paroxisme de fibrilație atrială (FA). Investigațiile efectuate: ECG, ECOCG coronaroangiografia, radiografia toracelui, USG, marcherii injuriei miocitare, analize hematologice și biochimice. Rezultate. Clinic: dureri retrosternale constrictive, dispnee inspiratorie la efort moderat, cefalee. Obiectiv: murmur vezicular în plămâni, zgomote cardiace ritmice, cu FCC 68 b/min, TA - 170/90 mmHg. Paraclinic: ECG: ritm sinusal cu FCC 66 b/min, hipertrofie VS, bloc i/ complet de ram stâng a f. Hiss. EcoCG: Stenoză aortică degenerativă. Hipochinezia miocardului peretelui inferior al VS. Insuficiența VM gr. II. FE 56%. Coronaroangiografia: leziuni aterosclerotice tricoronariene. Stenoze severe pe RCA 7590%; moderat severe pe LAD și pe CX (25-50%). Markerii injuriei miocitare în limite normale, glucoza (8,11 mmol/l), dislipidemie, leucociturie. Tratament conform protocolului cu: nitrați, blocanții canalelor de calciu, antiagregante și antidiabetice. Concluzii. Pacienta cu diabet zaharat dezvoltă un SCA cu manifestări clinice neexpresive, paraclinic confirmat prin hipochinezia peretelui inferior VS și leziuni aterosclerotice tricoronariene, ce permite administrarea tratamentului adecvat și facilitează pronosticul.Introduction. Coronary artery disease (CAD) develops in 25% of patients with diabetes mellitus (DM) and presents in-hospital death in 4.8%, at 30 days (6.7%) and at 1 year (13.7%). Dyslipidemia in DM is associated with vulnerable atherosclerotic plaques that assess with silent recurrent acute coronary syndromes (ACS). The purpose of the work. We present the clinical case of a patient with DM, HTN, known to have ischemic heart disease (IHD), silent angina pectoris (sAP), who was accidentally diagnosed with degenerative aortic stenosis and tricoronary atherosclerotic lesions. Materials and methods. Woman, 70 years old, hospitalized with AP and HTN gr.II. HTN for 20 years, AP for 12 years and paroxysms of atrial fibrillation (AF). Investigations performed: ECG, ECHOCG coronary angiography, chest x-ray, USG, markers of myocyte injury, hematological and biochemical analyses. Results. Clinical: constrictive retrosternal pain, inspiratory dyspnea, headache. Objective: vesicular murmur in the lungs, HR 68 b/min, BP - 170/90 mmHg. ECG: sinus rhythm with HR 66 b/min, LV hypertrophy, incomplete block of the left branch of f. Hiss. EcoCG: Degenerative aortic stenosis. Myocardial hypokinesia of the lower LV wall. Insufficiency of MV gr. II. EF 56%. Coronary angiography: tricoronary atherosclerotic lesions. Severe stenosis on RCA 75-90%; moderately severe on LAD and CX (25-50%). Markers of myocyte injury within normal limits, glucose (8.11 mmol/l), dyslipidemia, leukocyturia. Treatment according to the protocol with: nitrates, calcium channel blockers, antiplatelets and antidiabetics. Conclusions. The patient with diabetes develops an acute coronary syndrome with non-expressive clinical manifestations, paraclinically confirmed by hypokinesis of the lower LV wall and tricoronary atherosclerotic lesions, which allows the administration of appropriate treatment and facilitates the prognosis

Osteosynthesis in multiple fractures in children

State University of Medicine and Pharmacy "Nicolae Testemițanu", Republic of Moldova, MSPI DH Comrat, MSPI DH Teleneşti, MSPI MTA „Buiucani”, MSPI DH Orhei, Republic of Moldova, Al VIII-lea Congres Naţional de Ortopedie și Traumatologie cu participare internaţională 12-14 octombrie 2016Objective of study. To estimate the surgical treatment tactics and technique in multiple fractures in children in order to improve results. Material and methods. Over the past 25 years 131 children with multiple fractures of long bones received specialized treatment in the pediatric orthopedic clinic. There was prevalence of male patients (59.5%) aged over 10 years (65.6%). Of the total number of children, 294 fractures were assessed. Of them, 81 femoral fractures, 66 forearm fractures, 65 leg fractures, 60 arm fractures and others. Fractures due to road accidents prevailed (over 52%). After clinical and laboratory examinations carried out in intensive care unit and necessary preparation, the children were subjected to surgery under general anesthesia in order to appropriately reposition fragments and to perform osteosynthesis (except 29 fractures without displacement of fragments). Results. In metaphyseal, epi-metaphyseal, epiphyseal, and metaphyseal-diaphyseal fractures osteosynthesis was performed with Kirschner pins through cross insertion. In all operated cases fragments were consolidated without complications. Intramedullary osteosynthesis with metal rods, especially elastic ones was used in transversal diaphyseal fractures of the femur and forearm; while in oblique and spiroid diaphyseal fractures, osteosynthesis was additionally associated with cerclage wiring. Stable osteosynthesis was performed with the external Ilizarov apparatus in diaphyseal fractures of the leg. In diaphyseal humeral fractures, osteosynthesis was performed with elastic rods or Ilizarov pins, using the principles of TEN method. In open fractures, after primary surgical wound treatment, osteosynthesis was performed with pins or external devices. Discussions. The outcomes of surgical treatment in multiple fractures directly depend on the location of fractures, the quality of surgery, compliance with the requirements of biological osteosynthesis with endosteal and periosteal protection. We consider inadmissible to perform on children osteosynthesis with massive screwed plates as well as major removal of periosteum from bone. Conclusion. The basic treatment in multiple fractures is the surgical one, being carried out in one stage in the following order: open fractures, intra-articular fractures, fractures of the femur, leg, upper arm, forearm; biological minitraumatic osteosynthesis

The Folklore Archive of the Russian State University for the Humanities in MoscowFolklorni arhiv Ruske državne univerze za humanistične vede v Moskvi

The subject of the article is the field research of the folk tradition of the northern Russian area (the region of Kargopol, Archangelskaya oblast), led by the folklore and ethnolinguistic expedition of the Russian State University for the Humanities (RSUH) since 1993 until now, and the expedition data archive. The expeditions are organized 1–3 times a year, the participants include professors, postgraduate and undergraduate students of the RSUH. Several groups take part in the expedition, each consisting of 10–15 people who investigate one village during 2–4 weeks. The expedition is aimed at collecting ethnographic, ethnolinguistic and folkloric data, which could give a researcher the opportunity to get as detailed as possible a description of a modern folk culture state in the region.The main method of the field research used during the expedition work is interviewing a considerable part of the village inhabitants – about 20-60% – using 27 questionnaires that concern different spheres of the traditional culture, the audio records are later deciphered, and deciphered texts make the card index.The computer version of the archive has been created in the Laboratory of Folklore since 1997. The multimedia database “Traditional culture of Northern Russia (Kargopol region)” contains written texts, audio records of some fragments of interviews and graphic data (photos, scanned manuscripts, containing incantations, prayers, songs, etc). The database includes now about 20% of all archive materials. The card index contains about 120000 cards, while the database – about 23000 cards

Efeitos da finasterida sobre culturas de células epiteliais prostáticas normais e tumorais em diferentes sistemas in vitro

O câncer de próstata (CaP) é importante causa de morte no mundo. Além do óbvio impacto na vida pessoal do paciente e na sua família, no Brasil esta doença gera custos altíssimos para o Sistema Único de Saúde (SUS), desde o diagnóstico até o óbito. As terapias disponíveis, além de causarem complicações e efeitos colaterais indesejáveis, não proporcionam sobrevida alta ao paciente. Além disso, os casos de cura são restritos aos diagnosticados precocemente, e com intervenção rápida, antes que o tumor se torne resistente à castração química. Neste sentido, estratégias preventivas são desejáveis para a diminuição da incidência e óbitos e, dentre elas, o uso da finasterida, um fármaco inibitório da enzima 5-α-redutase, foi proposto como potencial agente quimiopreventivo após estudo conduzido pelo Prostate Cancer Prevention Trial, que demonstrou significante diminuição na incidência de CaP no grupo de pacientes tratados, em comparação ao grupo controle. No entanto, mesmo com resultados promissores, foi detectado aumento, também significante, do número de casos de cânceres mais agressivos (alto grau) no grupo de pacientes que recebeu finasterida, em comparação aos pacientes do grupo controle. Após intenso debate entre urologistas, biologistas e cancerologistas, ainda não há consenso sobre a natureza artefatual ou de real indução de cânceres mais agressivos pela finasterida. O órgão regulatório americano Food and Drugs Administration (FDA) declarou que o aumento dos casos agressivos pela finasterida não deve ser negligenciado, e recentemente proibiu o uso deste fármaco como quimiopreventivo para o CaP. Uma vez que casos agressivos de câncer estão comumente relacionados à superexpressão de enzimas...Prostate cancer (PCa) is an important death cause in Brazil and other countries. Besides the obvious impact at patient’s life, and their relatives, this disease consumes exorbitant resources from the Sistema Único de Saúde (SUS), from diagnosis to death. The available therapies not only cause undesirable complications and side effects, but also are inefficient at providing good survival expectancies for those affected. Moreover, the cure is only possible when the tumors are readily found and when the intervention is fast enough to prevent that the tumor become castration-resistant. In this sense, preventive strategies are desirable in order to lower incidence and death, and amongst them, finasteride (Fin) treatment, an inhibitor of the 5-alpha reductase enzyme, was proposed as a potential chemopreventive agent after the study conducted by the Prostate Cancer Prevention Trial reported a significant lower incidence of PCa cases on Fin-treated patients, when compared to control patients. However, even though these results were promising, this study also reported a significant increase on more aggressive, high-grade PCa, amongst Fin-treated patients, compared to those not exposed to Fin. After an intense debate about factual or artifactual Fin-induced high-grade PCa cases, between urologists, biologists and oncologists, there are still no decisive conclusions on this matter. The regulatory USA organ, Food and Drugs Administration (FDA), has recently declared that the higher incidence of a more serious form of PCa at the Fin-treated patients must not be neglected, and prohibited its use as a chemopreventive agent. Given that the aggressive cancer cases are commonly associated with the super-expression of matrix metalloproteinases (MMPs) enzymes, with consequently higher invasion and migration potential of tumor... (Complete abstract click electronic access below)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

Avaliação de novas propostas em arcabouços tridimencionais (3D) para cultura de células-tronco mesenquinas e condogênese

Levando-se em consideração avanços tecnológicos na área médica e o impacto dos programas de saúde que determinaram curvas de longevidade cada vez maiores e taxas de natalidade cada vez menores, o novo desafio do gestor público são as conseqüências: o envelhecimento e a vida como uma “doença crônica”. Entre os principais desafios está a abordagem das doenças crônico-degenerativas que determinam o aumento de lesões cartilaginosas articulares. A débil capacidade de regeneração e as limitações das alternativas de tratamento fazem as técnicas derivadas da biotecnologia, como o transplante autólogo de condrócitos (TAC) e o uso de células-tronco, o foco das investigações. O TAC requer coleta de material cartilaginoso de área sadia, podendo causar nova lesão; no entanto, pode-se evitar este perigo com o uso de células-tronco. As células-tronco mesenquimais, adultas, podem se diferenciar em condrócitos mediante o uso de meio de cultura específico em consonância a um arcabouço 3D, mas muitos problemas como evitar a calcificação e estimular a condrogênese em meio favorável constituem o desafio para os pesquisadores na atualidade. 1) produzir anticorpo monoclonal específico a CTMs de coelho para monitorá-las, 2) determinar o volume ideal de coleta de medula óssea para microencapsulação e condrogênese, 3) realizar a microencapsulação das CTMs em novos arcabouços: BIOGEL3D e BACTCELL3D, comparando seu desempenho com o modelo clássico em alginato. Foram utilizados 25 coelhos Nova Zelândia sendo divididos em diferentes grupos em função do volume de MO coletado: G1 = 6mL, G2 = 9mL, G3 = 12mL, G4 = 15mL e G5 = volume ideal de coleta determinado pelos indicadores dos outros grupos. O material coletado foi diluído 1:2 em RPMI 1640 com 3.000U de heparina sódica. Após a contagem celular, as amostras foram submetidas a separação em gradiente...Technological advances in the medical area combined with the impact of health programs that enhance longevity, together with lower natality rates created new challenges to the public manager such as aging and life as a “chronic disease”. Among the major problems are the chronic degenerative diseases that increase articular lesions. The limited regeneration capabilities and the limitations of actual treatment alternatives made biotechnology derived techniques the focus of investigations. The autologous chondrocyte transplantation (ACT) requires a small biopsy of health cartilage, which can lead to a new lesion. However, the use of stem cells can avoid this possibility. Mesenchymal stem cells (MSCs) can differentiate into chondrocytes by using a specific culture medium together with a 3D scaffold, but some questions such as the risks of calcification remain as key factors to researchers. 1) to produce a monoclonal antibody that recognizes MSCs in order to characterize them, 2) to determine the optimal bone marrow collection volume for cell microencapsulation and chondrogenesis and 3) to microencapsulate MSCs in two novel scaffolds: BIOGEL3D and BACTCELL3D, comparing them with sodium alginate. 25 New Zealand rabbits were divided into 5 groups related to bone marrow collection volume: G1 = 6mL, G2 = 9mL, G3 = 12mL, G4 = 15mL and G5 = optimal volume determined by the study. The collected material was diluted in RPMI1640 medium 1:2, with 3000U sodium heparin. After cell count and viability assessment the samples were submitted to density gradient centrifugation in order to isolate the lymphomononuclear (LMN) fraction. These cells were seeded to obtain and expand the MSCs in DMEM Knockout® (InvitrogenTM) supplemented with antibiotic/antimycotic, Lglutamine, essential aminoacids, non essential aminoacids and fetal bovine serum (all from InvitrogenTM). The cells were cultivated in 5% CO2 ...(Complete abstract click electronic access below)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq

Platelet-Rich Plasma And Chronic Wounds: Remaining Fibronectin May Influence Matrix Remodeling And Regeneration Success

Background: Platelet-rich plasma has been largely used as a therapeutic option for the treatment of chronic wounds of different etiologies. The enhanced regeneration observed after the use of platelet-rich plasma has been systematically attributed to the growth factors that are present inside platelets' granules. Aim: We hypothesize that the remaining plasma and platelet-bound fibronectin may act as a further bioactive protein in platelet-rich plasma preparations. Methods: Recent reports were analyzed and presented as direct evidences of this hypotheses. Results: Fibronectin may directly influence the extracellular matrix remodeling during wound repair. This effect is probably through matrix metalloproteinase expression, thus exerting an extra effect on chronic wound regeneration. Conclusions: Physicians should be well aware of the possible fibronectin-induced effects in their future endeavors with PRP in chronic wound treatment. © 2013 International Society for Cellular Therapy