Single cell dissection of plasma cell heterogeneity in symptomatic and asymptomatic myeloma

Multiple myeloma, a plasma cell malignancy, is the second most common blood cancer. Despite extensive research, disease heterogeneity is poorly characterized, hampering efforts for early diagnosis and improved treatments. Here, we apply single cell RNA sequencing to study the heterogeneity of 40 individuals along the multiple myeloma progression spectrum, including 11 healthy controls, demonstrating high interindividual variability that can be explained by expression of known multiple myeloma drivers and additional putative factors. We identify extensive subclonal structures for 10 of 29 individuals with multiple myeloma. In asymptomatic individuals with early disease and in those with minimal residual disease post-treatment, we detect rare tumor plasma cells with molecular characteristics similar to those of active myeloma, with possible implications for personalized therapies. Single cell analysis of rare circulating tumor cells allows for accurate liquid biopsy and detection of malignant plasma cells, which reflect bone marrow disease. Our work establishes single cell RNA sequencing for dissecting blood malignancies and devising detailed molecular characterization of tumor cells in symptomatic and asymptomatic patients

Ultrasonographic Evaluation of Normal and Pathologic Puerperium

Puerperium represents a period of profound physiological and anatomical changes aimed to return to the pre-pregnancy state. As showed by the almost half maternal deaths reported related to this period, the correct diagnosis and treatment of any complication is of paramount importance. In this scenario, the ultrasonographic evaluation has a key role as first level tool to identify and diagnose any complication and to address the cause of any pathological sign and symptom. Ultrasound evaluation is able to identify or exclude retained products of conception or arteriovenous malformations in case of postpartum hemorrhage. Moreover, ultrasound allows to identify and monitor post-surgical complications after cesarean section, such as postpartum hematomas and/or pelvic abscess. Although the key role of this diagnostic tool, the reported reliability and validity of ultrasounds in the assessment of the different complications is heterogenous, and the limited specificity and sensitivity of different ultrasound appearances need to be taking into account. To address this issue, the knowledge of normal ultrasonographic appearance of genital tract during the physiological puerperal involution is the first step to achieve an accurate distinction between normal and abnormal development of puerperium