The Expression of Tumor-Associated Macrophages and Multinucleated Giant Cells in Papillary Thyroid Carcinoma

BACKGROUND: Inflammation that occurred in the tumor microenvironment was characterized by abundant macrophage infiltration, playing role in innate immunity. Multinucleate giant cells (MGCs) occur in a variety of inflammatory, hyperplastic, and neoplastic thyroid disorders. They also have been recognized as a feature of papillary thyroid carcinoma (PTC). AIM: The aim of this study was to evaluate cases of PTC for the presence of macrophages, and estimate CD68+ TAMs density in tumor stroma, margin and the surrounding tissue. We assessed also MGCs. METHODS: Macrophages and MGCs densities were correlated with clinicopathologic parameters to assess the possible prognostic significance. We investigated 56 patients immunohistochemically and immunofluorescence with antibodies against CD68 and IL-17. RESULTS: A statistically significant correlation was established between PTC patients in III stage, containing many MGCs, and PTC in I and II stage, with many MGCs. Eighty Percent of patients in III stage showed many MGCs in comparison with patients in I and II stage, where many MGCs were found only in 21,1% (χ2 = 6.189, p = 0.013). CONCLUSION: Our study demonstrates that the increased density of MGCs is associated with advanced stage of PTC, and therefore with tumor progression and that cases of PTC should be carefully screened for their presence

Измерения на съвременното постмодерно поклонничество като глокално религиозно културно наследство

Съвременните практики на почивно и конфесионално пътуване и посещение на свети места на различни деноминации съсредоточава множество ориентации и нагласи, свързани с религиозното културно наследство. Постмодерният туристически опит в организация и изследвания обхваща обширно пространство от местното до глобалното, от материалното до незримото, от забравеното до живото наследство, от устойчивото до динамичното, от субективното до общовалидното, общоприетото и общочовешкото в религиозната култура и ежедневния живот. Трансмисията на традиционни ценности и ритуали, както и актуализацията на културни практики, базови за религиите, вероизповеданията и общностите биха била невъзможна без сакралните топоси като фокус на туристически интерес, човекопоток и динамична експлоатация на обекти и без развитието на рефлексията на тези процеси. С оглед на съобразяването на религиозни и граждански права, мотивации, интереси и нагласи за устойчиво развитие и престижна идентичност, не по-малко важни от ценностите на демократично обществено съзнание, геополитически, национален и етнически баланс, са възможностите на обществените науки и структури за оптимални социални политики и грижи, насочени към цялото разнообразие от неравнопоставености.Contemporary practices of recreational and confessional travel and visit of sacred sites of various denominations focus multitude of orientations and attitudes regarding religious cultural heritage. Postmodern tourist experience of organisation and research encompasses wide space from local to global, from material to invisible, form forgotten to live heritage, and from sustainable to dynamic, from subjective to generally valid, acknowledged, and human in religious culture and everyday life. Transmission of traditional values and rituals, as well as actualisation of cultural practices basic for religions, confessions, and their communities would be impossible without sacral topoi as a focus of tourist interests, flow of people and dynamic site exploitation, and without development of the reflection on those processes. In regard of adjustment of religious and civic rights, motivations, interests and attitudes for sustainable development and representative identity, not only values of democratic social awareness, geopolitical, national, or ethnic balance are important, but as well the potential of social studies and structures to maintain optimal social policies and care addressing whole variety of uneven statuses

The challenge - pediatric pulmonology emergencies

Заболяванията на дихателната система в детска възраст се нареждат на първо място по честота в детската патология. Коректно снетата анамнеза, познаването на симптомите, адекватната и бърза реакция от страна на специалистите определя изхода на заболяването и неговите усложнения. Спешните състояния в детската пулмология са чести и представляват сериозно предизвикателство за общопрактикуващи лекари, педиатри, пулмолози, специалисти по здравни грижи. Познаването на причините за дихателна недостатъчност в детска възраст дава възможност за насоченото им търсене и своевременна бърза преценка и подход. Като най-чести спешни състояния на дихателната система, свързани с проявите на дихателна недостатъчност в детска възраст, са: аспирация, чуждо тяло, епиглотит, ларингит, пневмония, бронхиална астма. Преценката, бързината в амбулаторни и болнични условия при дете със спешно състояние на дихателната система е изключително важен момент, определящ изхода на заболяването.Respiratory diseases in children are the leader in frequency in pediatric pathology. A properly examined medical history, knowledge of the symptoms, an adequate and prompt reaction by the specialists determine the outcome of the disease and any following complications. Emergency conditions in pediatric pulmonology are frequent and they present a serious challenge for general practitioners, pediatricians, pulmonologists, healthcare professionals. Knowing the causes for respiratory insufficiency in children allows for their accurate identification and a rapid evaluation and adequate approach. The most frequent emergency conditions, associated with the occurrence of respiratory insufficiency in children are: aspiration, foreign body, epiglottitis, laryngitis, pneumonia, bronchial asthma. The judgment, the swiftness in ambulatory and hospital conditions in regards to a child with an emergency condition of the respiratory system are of utmost importance, determining the outcome of the disease

Cerebral Aspergilloma in Patient with Diabetes – A Case Report with Short Literature Review

BACKGROUND: In the recent years, the incidence of fungal brain abscess has been rising as a result of the increased use of corticosteroid therapy, broad-spectrum antimicrobial therapy, and immunosuppressive agents. Aspergillosis of the central nervous system (CNS) is reported in 10%–20% of the patients having invasive fungal disease. Commonly, the disease is observed in immunocompromised or immunosuppressed patients; also, patients who suffered traumatic head injury are reported as well to develop the infection due to due cranial defect accompanied by dural tearing. Symptoms are non-specific neurologic manifestations. CASE PRESENTATION: We presented a case of a 68-year-old man who had diabetes mellitus type II. He was admitted to in neurosurgery clinic due reported head trauma. Initially, he complained of a headache, dizziness, slurred speech, nausea, and pain in the right ear with tinnitus and pain in his right upper teeth – continuous for a month. The patient was conscious, adequate, Glasgow Coma Scale – 15 points, with left-sided hemiparesis, general symptomatic syndrome. An emergent computed tomography scan was performed, which showed tumorous formation in patient’s right temporal lobe that had mass effect and compression of the right lateral ventricle. The patient was discussed on a emergent clinical counsel and it was decided that he was shown for surgical treatment. An informed consent was signed by the patient and his relatives. After the surgery intervention – the histological result of the biopsy was aspergilloma of the brain and the microbiological result was Aspergillus fumigatus. CONCLUSION: The prognosis for CNS aspergillosis is poor, but the early diagnosis and effective medical and surgical treatments may reduce morbidity and mortality. &nbsp

The Role of the Molecular Subtypes in the Prognosis of Breast Cancer Patients

BACKGROUND: Understanding the biology of the tumor, by dividing it into molecular subtypes, has made it possible to individualize the therapeutic approach in high-risk patients. AIM: We aimed to determine the importance of established molecular subtypes in the prognosis and the importance of disease-free and overall survival (OS) in patients with non-metastatic breast cancer. MATERIALS AND METHODS: We analyzed 94 patients with non-metastatic breast cancer for the period 2010–2018. The median follow-up time was 60 months. The mean age in the study group was 60.03 years (SD ± 10.52). According to the characteristics of the studied indicators, we divided the group into Luminal A (n-59 [62.7%]), Luminal B/HER2 (−) (n-2 [2.1%]), Luminal B/HER2 (+) (n-8 [8.5%]), HER2 overexpressing (n-3 [3.2%]), and triple-negative subtype (n-22 [23.5%]). In all patients in the study group, we analyzed the 5-year overall survival (OS) and disease-free survival (DFS) and referred it to molecular subtypes, lymphatic status, HER-2 status, the presence or absence of endocrine therapy for the follow-up period, tumor differentiation, and type of surgery. RESULTS: We observed the 5-year OS in 92% of patients identified as Luminal A; at 50% of Luminal B/HER2 (−) neg.; in 62.5% with Luminal B/HER2 (+), in 67% with HER2-overexpressing carcinoma; and in 66.7% of patients with triple-negative subtype. The total cancer-associated mortality rate in the analyzed period reached 15.9% (n = 15). Patients with mastectomy (p = 0.019, p = 0.027), positive axilla with more than 4 lymph node (LN) (p = 0.000; p = 0.000), and Luminal B/HER-2 (+) tumors (p = 0.004; p = 0.003) were the independent prognostic factors for worse DFS and OS in our study group. Histological differentiation and HER-2 expression were in unsatisfactory correlation (p = 0.077; p = 0.044 and p = 0.081; p = 0.055, respectively). CONCLUSION: Molecular subtypes are essential in the prognosis of breast cancer and maybe a criterion for an individualized therapeutic approach

The Position of Neutrophils-To-Lymphocytes and Lymphocytes-To-Platelets Ratio as Predictive Markers of Progression and Prognosis in Patients with Non-Small Cell Lung Cancer

BACKGROUND: Non-small cell lung cancer (NSCLC) is an insidious metastasis condition of the lungs often presenting no symptoms at the onset. Defining markers for quick determination of prognosis is essential for building up a treatment strategy.AIM: The aim of this study is to define the role of the Neutrophils-to-Lymphocytes ratio (NLR) and Platelets-to- Lymphocytes ratio (PLR) as biomarkers in patients with NSCLC, according to the stage and prognosis of the disease.METHODS: We investigated 20 patients with NSCLC. NLR and PLR are calculated and are evaluated according to the presence or absence of metastasis, stage of the disease, histological type and survival rate.RESULTS: We found that thirteen of the patients had low NLR, while the rest 7 had high NLR (mean 3.15). By analysing PLR we found that 11 patients have low and 9 have high level of PLR (mean 1.42). After the correlations have been made we discovered that in 90.1% of the patients with low PLR no lymph metastasises were detected, while in 50% of the patients with high PLR lymph metastasises were observed (c2 = 3.99; P = 0.046). We also discovered that in 84.6% of the patients with low NLR lymph metastases were absent, while in 42.9% with high NLR lymph metastasises were present (c 2 = 1.83; P = 0.176).CONCLUSION: In conclusion, NLR and PLR were discovered as prominent biomarkers which provide relatively fast determination for prognosis in patients with NSCLC

Immunohistochemical Expression of TGF-Β1, SMAD4, SMAD7, TGFβRII and CD68-Positive TAM Densities in Papillary Thyroid Cancer

BACKGROUND: Papillary thyroid carcinoma (PTC) accounts for 80% of the thyroid malignancies that are characterised by slow growth and an excellent prognosis. Over-expression of SMAD4 protein restores TGF-β signalling, determines a strong increase in anti-proliferative effect and reduces invasive potential of tumour cells expressing it.AIM: The study aimed to analyse the immunohistochemical expression of TGF-β1 and its downstream phosphorylated SMAD4, element and of the inhibitory SMAD7 PTC variants and their association with the localisation of TAMs within the tumour microenvironment.METHODS: For this retrospective study we investigated 69 patients immunohistochemistry with antibodies against TGF-β, TGF – β-RII, SMAD4, SMAD7, CD68+ macrophages.RESULTS: Patients with low infiltration with CD68+ cells in tumour stroma has significantly shorter survival (median of 129.267 months) compared to those with high CD68+ cells infiltration (p = 0.034). From the analysis of CD68+ cells in tumour border and tumour stroma correlated with expression of TGF-β1 / SMAD proteins, we observed that the positive expression of TGF-β1 in tumour cytoplasm, significantly correlated with increased number of CD68+ cells in tumour border (X2 = 5,945; р = 0.015).CONCLUSION: TGF-β enhances motility and stimulates recruitment of monocytes, macrophages and other immune cells while directly inhibiting their anti-tumour effector functions

The role of CD68 positive tam in development of non-small cell lung cancer

Non-small cell lung cancer (NSCLC) is a leading cause of cancer related mortality. Main factors of development of NSCLC are many immune cells involved in tumor microenvironment. Infiltration with CD68 positive tumor associated macrophages (TAM) in the tumor stroma or in the tumor islets is associated with prognosis and stage of the disease for a long time. Investigating immunohistochemically 40 patients with NSCLC we discovered that 25% of patients with metastasis in lymph nodes had low infiltration with TAM in the tumor border, while 35.7% of the patients without metastasis- the infiltration was high (х2=5.19; р=0.023). We also discovered that all patients in stage I and 66.7% of the patients in stage II had low infiltration with TAM in the tumor border, while 100% of those in stage IV had high infiltration in the border (x2=5.44; p=0.02). In addition, we observed that 52.9% of the patients in T3-4 the infiltration of the tumor border with TAM was high, while only 16.7% of those in T1-2 had high infiltration (x2=2.92; p=0.087). In investigated by our team lung cancers, clear associations were established between CD68 positive cells density in the tumor border and stage of the disease