Dezvoltarea tumorilor maligne secundare la pacienţii cu Limfom Hodgkin

Din 1240 de cazuri de limfom Hodgkin, la 57 (4,5%) de bolnavi au fost depistate tumori secundare maligne. La 5 pacienţi dezvoltarea lor a fost sincronă. În 6 cazuri limfomul Hodgkin s-a dezvoltat metacron faţă de alte trei tumori primare solide şi trei maladii limfoproliferative cronice. În 46 de cazuri tumorile secundare maligne s-au dezvoltat după 3-30 ani de la tratamentul limfomului Hodgkin. Numai la un pacient după 3,5 ani de la tratamentul combinat chimioradioterapeutic s-a diagnosticat leucemie acută mieloblastică. La ceilalţi 45 de bolnavi s-au dezvoltat tumori secundare solide. Localizarea lor a fost variată şi, de regulă, nu a depins de caracterul şi zonele iradiate anterior. La fi ecare al cincilea bolnav s-au înregistrat câte 2-3 tumori secundare maligne, majoritatea din ele caracterizându-se prin rezistenţă la tratamentul administrat

Clinical evolution peculiarities of Hodgkin’s disease in pregnancy and after delivery in patients who underwent radiotherapy by radical or widening programme

Catedra Hematologie, Oncologie şi Terapie de Campanie Instituţia Medico-Sanitară Publică, Institutul de Oncologie din R.MoldovaThe influence of pregnancies (105) and deliveries (63) on Hodgkin’s disease evolution have been studied in 78 patients after radiotherapy by a radical or widening programme. There were 29 pregnancies and 5 childbirths in 27 women in the active period of Hodgkin’s disease. There was a medical abortion in 24 cases. All of them had a developing Hodgkin’s disease after pregnancy and delivery. In the remission period of Hodgkin’s disease 76 pregnancies in 51 women ended in 58 childbirths. Pregnancy was interrupted in 18 cases. Only 6 patiens in this group were detected relapses. These were more frequent (31.25%) in the cases when pregnancy occurred in the first 3 years of remission. Much more rarelly (5.6%) relapses have been reported when pregnancy occurred 4-5 years after remission set up, whereas 6 and more years after remission relapses resullting from pregnancy haven’t been revealed. Thus, it’s necessary to interrupt the pregnancy in the active Hodgkin’s disease period, because of a great risc of relapses development. It’s possible to prezerve the pregnancy in stable and long Hodgkin’s disease remission due to the minimal risc of relapses. A fost studiată influenţa în 105 cazuri de sarcină şi 63 cazuri de naşteri asupra evoluţiei limfomului Hodgkin la 78 paciente după radioterapie conform programului radical sau desfăşurat. În perioada activă a limfomului Hodgkin la 27 femei 29 de sarcini s-au terminat cu 5 naşteri. În 24 de cazuri a fost avort medical. La toate aceste paciente s-a constatat progresarea maladiei. În perioada de remisiune a limfomului Hodgkin la 51 femei 76 de sarcini s-au terminat cu 58 naşteri. În 18 cazuri sarcina a fost întreruptă. În această grupă doar la 6 bolnave s-au depistat recidive. Mai frecvent (31,25%) acestea au fost depistate în cazurile când sarcina a survenit în primii 3 ani de remisiune. Mult mai rar (5,6%) recidive s-au înregistrat când sarcina a apărut în decurs la 4-5 ani de remisiune, iar după 6 ani şi mai mult recidive în urma sarcinii nu s-au depistat. Aşadar, în perioada activă a limfomului Hodgkin sarcina necesită a fi întreruptă din cauza riscului înalt de dezvoltare a recidivelor. În cazurile remisiunilor stabile şi îndelungate sarcina poate fi păstrată, deoarece riscul dezvoltării recidivelor este minimal

Functional ultrasound imaging for assessment of extracellular matrix scaffolds used for liver organoid formation

A method of 3D functional ultrasound imaging has been developed to enable non-destructive assessment of extracellular matrix scaffolds that have been prepared by decellularization protocols and are intended for recellularization to create organoids. A major challenge in organ decellularization is retaining patent micro-vascular structures crucial for nutrient access and functionality of organoids. The imaging method described here provides statistical distributions of flow rates throughout the tissue volumes, 3D vessel network architecture visualization, characterization of microvessel volumes and sizes, and delineation of matrix from vascular circuits. The imaging protocol was tested on matrix scaffolds that are tissue-specific, but not species-specific, matrix extracts, prepared by a process that preserved >98% of the collagens, collagen-associated matrix components, and matrix-bound growth factors and cytokines. Image-derived data are discussed with respect to assessment of scaffolds followed by proof-of-concept studies in organoid establishment using Hep3B, human hepatoblast-like cells. Histology showed that the cells attached to scaffolds with patent vasculature within minutes, achieved engraftment at near 100%, expressed liver-specific functions within 24h, and yielded evidence of proliferation and increasing differentiation of cells throughout the two weeks of culture studies. This imaging method should prove valuable in analyses of such matrix scaffolds

Diabetes mellitus en pacientes con enfermedad de Alzheimer: descripción clínica y correlación con el genotipo APOE en una muestra de población del departamento de Antioquia, Colombia

Introduction. Alzheimer’s disease is a multifactorial disease affecting approximately twenty million people worldwide. Numerous variables are associated with increased risk of developing this severe neurological disorder. Among the risk factors, diabetes mellitus, and the ε4 isoform of the APOE gene have been amply demonstrated as increasing the risk of developing this disease.Objective. To determine if a correlation exists between APOE genotype, diabetes mellitus and Alzheimer’s disease.Materials and methods. Clinical studies were carried out by surveying the clinical histories in a group of patients in the province of Antioquia, Colombia. Forty-three Alzheimer’s patients were compared with 43 control subjects, paired by age and gender. Commercially available methods were used to determine whether the patients had diabetes, and restriction enzyme-based genotyping was used to determine the APOE genotypes.Results. The most common non-neurological comorbidities were: arterial hypertension, acute myocardial infarction, chronic obstructive pulmonary disease and hypothyroidism. From the many variables investigated, two were conclusive: (1) the presence of Alzheimer’s disease was higher in patients with diabetes mellitus, and (2) no correlation between late-onset sporadic Alzheimer’s disease and APOE was found in the target population.Conclusions. To detect any association with the APOE genotype, a study involving much a larger population samples must be undertaken.Introducción. La enfermedad de Alzheimer es compleja y afecta, aproximadamente, a 20 millones de personas en todo el mundo. Muchas variables parecen aumentar el riesgo de desarrollar esta alteración neurológica. Entre los factores de riesgo, se ha demostrado ampliamente que la diabetes mellitus y la isoforma ε4 del gen APOE tienen incidencia positiva en el desarrollo de la enfermedad. Se reporta un estudio en el cual se investigó la posible correlación entre APOE, diabetes mellitus yla enfermedad de Alzheimer, en un grupo específico de pacientes del departamento de Antioquia, Colombia.Objetivo. Determinar si existe una correlación entre APOE, diabetes mellitus y la enfermedad de Alzheimer, en un grupo de pacientes de Antioquia, Colombia.Materiales y métodos. Se buscaron y analizaron las historias clínicas de los pacientes con diagnóstico de enfermedad de Alzheimer. Se seleccionaron aquellos que cumplían los criterios de inclusión. Se utilizaron métodos comercialmente disponibles para confirmar la presencia de diabetes mellitus. La genotipificación de APOE se hizo con un método basado en la PCR y la digestión con enzimas de restricción, en muestras de todos los participantes en el estudio.Resultados. En este estudio se analizan 43 casos de enfermedad de Alzheimer y 43 individuos sanos controles, pareados por edad y sexo. Las enfermedades concomitantes no neurológicas más comunes fueron: hipertensión arterial, infarto agudo del miocardio, enfermedad pulmonar obstructiva crónica e hipotiroidismo.Conclusiones. De las diferentes variables investigadas, dos arrojaron resultados concluyentes: i) la presencia de la enfermedad de Alzheimer es más frecuente en pacientes con diabetes mellitus, y 2) no se encontró correlación entre la enfermedad de Alzheimer de inicio tardío esporádico y el genotipo de APOE. Es importante indicar que debe llevarse a cabo un estudio con un tamaño de población mayor, para determinar cualquier posible correlación o inferencia con el genotipo de APOE. doi: http://dx.doi.org/10.7705/biomedica.v32i2.579

Do looks matter? The role of the Electronic Residency Application Service photograph in dermatology residency selection

Background: There is a lack of research on the impact of the Electronic Residency Application Service (ERAS) photograph on the residency selection process.Objective: We sought to elucidate the role of the ERAS photograph in the dermatology residency selection outcome and to determine if photographs submitted by matched applicants differ from those of unmatched applicants.Methods: We analyzed ERAS photographs submitted by dermatology residency applicants based on photograph characteristics related to composition, attire, facial expression, hairstyle, and accessories.Results: Candidates who smiled, wore glasses, and wore jackets in their photographs were more likely to match. There was no difference in the rate of matching among applicants depending on whether their photograph was of professional quality or whether they wore formal attire in their pictures. Gender specific characteristics were not found to be influential in the match outcome for male applicants. Among female applicants, having hair to the shoulders or longer was associated with a positive match outcome.Conclusion: Certain characteristics of the ERAS photographs were found to be associated with a more favorable match outcome. Further biases inferred from these photographs might be present in the dermatology selection process. We suggest blinding the selection committees to ERAS application photographs prior to granting residency interviews

Do looks matter? The role of the Electronic Residency Application Service photograph in dermatology residency selection

Background: There is a lack of research on the impact of the Electronic Residency Application Service (ERAS) photograph on the residency selection process.Objective: We sought to elucidate the role of the ERAS photograph in the dermatology residency selection outcome and to determine if photographs submitted by matched applicants differ from those of unmatched applicants.Methods: We analyzed ERAS photographs submitted by dermatology residency applicants based on photograph characteristics related to composition, attire, facial expression, hairstyle, and accessories.Results: Candidates who smiled, wore glasses, and wore jackets in their photographs were more likely to match. There was no difference in the rate of matching among applicants depending on whether their photograph was of professional quality or whether they wore formal attire in their pictures. Gender specific characteristics were not found to be influential in the match outcome for male applicants. Among female applicants, having hair to the shoulders or longer was associated with a positive match outcome.Conclusion: Certain characteristics of the ERAS photographs were found to be associated with a more favorable match outcome. Further biases inferred from these photographs might be present in the dermatology selection process. We suggest blinding the selection committees to ERAS application photographs prior to granting residency interviews

Differentially charged isoforms of apolipoprotein E from human blood are potential biomarkers of Alzheimer’s disease

Introduction Alzheimer’s disease (AD) is the major cause of dementia among the elderly. Finding blood-based biomarkers for disease diagnosis and prognosis is urgently needed. Methods We studied protein distributions in brain tissues, cerebrospinal fluid (CSF), and blood of AD patients by using proteomics and a new proteomic method that we call “2D multiplexed Western blot” (2D mxWd). This method allows us to determine in multiple samples the electrophoretic patterns of protein isoforms with different isoelectric points. Results Apolipoprotein E (ApoE) displays a unique distribution of electrophoretic isoforms in the presence of AD and also a unique pattern specific to the APOE genotype. Conclusions The isoelectric distribution of differentially charged ApoE isoforms was used to determine the presence of AD in a small group of samples. Further studies are needed to validate their use as predictors of disease onset and progression, and as biomarkers for determining the efficacy of therapeutic treatments

Role of surgery and its indications in the treatment of autoimmune thrombocytopenia

USMF ”N. Testemițanu”, catedra Hematologie și Oncologie, IMSP IO laboratorul gastropulmonologie, Al XI-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova și cea de-a XXXIII-a Reuniune a Chirurgilor din Moldova „Iacomi-Răzeșu” 27-30 septembrie 2011Trombocitopeniile autoimune se dezvoltă în rezultatul formării anticorpilor împotriva trombocitelor proprii cu structura antigenică normală. Predomină trombocitopeniile idiopatice. Caracterul autoimun al trombocitopeniilor este confirmat prin normalizarea numărului de trombocite în rezultatul tratamentului cu corticosteroizi. Diagnosticul pozitiv al trombocitopeniilor autoimune idiopatice este bazat pe semnele clinice (hemoragii peteşiale cutanate şi pe mucoase, lipsa adenohepatomegaliei şi prezența splenomegaliei moderate doar într-o treime de bolnavi) indicii hemogramei (trombocita izolată fără modificări în seria granulocitară şi eritrocitară, megacariocite în măduva oaselor în cantitate normală sau în exces) şi prin excluderea altor cauze. Tratamentul include corticosteroizi, imunodepresante, şi vasoprotectori. Din corticosteroizi este recomandat prednizolonul, drept vasoprotectoare sunt indicați acidul ascorbic, Rutina, diținonul şi preparatele de calciu.În caz de eşec al tratamentului medicamentos sau în recidivele trombocitopeniei este recomandată Splenectomia.Mecanismul de eficacitate al splenectomiei este asigurat de înlăturarea organului, unde se produc anticorpii antitrombocitari, care distrug trombocitele.Splenectomia conduce la vindecarea în 86-96%. (I. Corcimaru). În clinica gastropulmonologie a Institutului Oncologic au fost operați pe parcursul anilor 2005-2011 34 de bolnavi cu trombocitopenie autoimună.Splenectomia a fost efectuată după indicațiile următoare: în 18 cazuri nu s-a înregistrat efect în urma tratamentului hormonal; în 12 cazuri la efectul incomplet persista sindromul hemoragic, cel mai frecvent în tegumente, iar în 3 cazuri cu hemoragii gastroduodenale; în 4 cazuri splenectomia a fost efectuată pe motive de recidivă a maladiei.La ora dispensarizării – mai 2011 toți bolnavii sunt în stare satisfăcătoare cu indicii hemogramei în special a trombocitelor în limitele normei. Concluzii: 1. Tratamentul chirurgical (Splenectomia) asigură vindecarea bolnavilor cu trombocitopenii autoimune. 2. Indicațiile în lotul nostru au fost: rezistența la tratamentul hormonal, pericolul hemoragiilor, îndeosebi a organelor viscerale şi nu în ultimul rând recidiva mala.Role of surgery and its indications in the treatment of autoimmune thrombocytopenia. Our study is founded on monitoring and surgical of 34 patients with autoimmune thrombocytopenia, for whom splenectomy was performed. Of indications by surgical treatment recorded these: in 18 cases hormonal treatment was without effect, in 12 cases – actually incomplete and hemorrhagic syndrome persistent, and in 4 cases – based on recurrence

Diabetes mellitus en pacientes con enfermedad de Alzheimer: descripción clínica y correlación con el genotipo APOE en una muestra de población del departamento de Antioquia, Colombia

Introducción. La enfermedad de Alzheimer es compleja y afecta, aproximadamente, a 20 millones de personas en todo el mundo. Muchas variables parecen aumentar el riesgo de desarrollar esta alteración neurológica. Entre los factores de riesgo, se ha demostrado ampliamente que la diabetes mellitus y la isoforma ε4 del gen APOE tienen incidencia positiva en el desarrollo de la enfermedad. Se reporta un estudio en el cual se investigó la posible correlación entre APOE, diabetes mellitus yla enfermedad de Alzheimer, en un grupo específico de pacientes del departamento de Antioquia, Colombia. Objetivo. Determinar si existe una correlación entre APOE, diabetes mellitus y la enfermedad de Alzheimer, en un grupo de pacientes de Antioquia, Colombia. Materiales y métodos. Se buscaron y analizaron las historias clínicas de los pacientes con diagnóstico de enfermedad de Alzheimer. Se seleccionaron aquellos que cumplían los criterios de inclusión. Se utilizaron métodos comercialmente disponibles para confirmar la presencia de diabetes mellitus. La genotipificación de APOE se hizo con un método basado en la PCR y la digestión con enzimas de restricción, en muestras de todos los participantes en el estudio. Resultados. En este estudio se analizan 43 casos de enfermedad de Alzheimer y 43 individuos sanos controles, pareados por edad y sexo. Las enfermedades concomitantes no neurológicas más comunes fueron: hipertensión arterial, infarto agudo del miocardio, enfermedad pulmonar obstructiva crónica e hipotiroidismo.Conclusiones. De las diferentes variables investigadas, dos arrojaron resultados concluyentes: i) la presencia de la enfermedad de Alzheimer es más frecuente en pacientes con diabetes mellitus, y 2) no se encontró correlación entre la enfermedad de Alzheimer de inicio tardío esporádico y el genotipo de APOE. Es importante indicar que debe llevarse a cabo un estudio con un tamaño de población mayor, para determinar cualquier posible correlación o inferencia con el genotipo de APOE.   doi: http://dx.doi.org/10.7705/biomedica.v32i2.57

Functional ultrasound imaging for assessment of extracellular matrix scaffolds used for liver organoid formation

A method of 3D functional ultrasound imaging has been developed to enable non-destructive assessment of extracellular matrix scaffolds that have been prepared by decellularization protocols and are intended for recellularization to create organoids. A major challenge in organ decellularization is retaining patent micro-vascular structures crucial for nutrient access and functionality of organoids. The imaging method described here provides statistical distributions of flow rates throughout the tissue volumes, 3D vessel network architecture visualization, characterization of microvessel volumes and sizes, and delineation of matrix from vascular circuits. The imaging protocol was tested on matrix scaffolds that are tissue-specific, but not species-specific, matrix extracts, prepared by a process that preserved >98% of the collagens, collagen-associated matrix components, and matrix-bound growth factors and cytokines. Image-derived data are discussed with respect to assessment of scaffolds followed by proof-of-concept studies in organoid establishment using Hep3B, human hepatoblast-like cells. Histology showed that the cells attached to scaffolds with patent vasculature within minutes, achieved engraftment at near 100%, expressed liver-specific functions within 24h, and yielded evidence of proliferation and increasing differentiation of cells throughout the two weeks of culture studies. This imaging method should prove valuable in analyses of such matrix scaffolds