Post-transplant lymphoproliferative disorder after heart transplantation

Post-transplant lymphoproliferative disorder (PTLD) is a heterogeneous group of lymphoid neoplasms associated with immunosuppression following solid organ transplantation or allogeneic hematopoietic stem cell transplantation. Mismatch for cytomegalovirus (CMV), such as when a seronegative recipient receives an organ from a seropositive donor, was shown to be associated with a seven-fold increase in PTLD. A 20-year-old male patient was admitted to the hospital due to back and abdominal pain. He had underwent a heart transplant 6 years ago due to postmyocarditic dilated cardiomyopathy and soon after the transplant, he had developed CMV pneumonitis. At examination, abdominal ultrasound showed multiple lesions of the liver, and patohystology of the lesion biopsy revealed PTLD, i.e. Non-Hodgkin’s diffuse large B cell lymphoma, for which the patient received 8 cycles of chemotherapy (R-CHOP protocol). Nine months after the first dose, the patient was admitted to the hospital due to simptoms of heart failure (NYHA IV) and echocardiography revealed significantly reduced cardiac function (LVEF 25%). Graft rejection was excluded with heart biopsy and it was concluded the etiology of heart failure was anthracycline (Doxorubicin) toxicity. Given the severity of the patient’s condition, he was again listed for heart transplant, and ultimately, retransplanted. Eight years after the retransplant, the patient is in excellent overall condition. Heart transplant patients have about a 1- 6% risk to develop the PTLD. The incidence of chronic Doxorubicin cardiotoxicity is about 1.7%. This patient had developed both, but, fortunately, with timely and right therapy the outcome can be successful

Everything in Moderation – Athlete\u27s Heart

Brojna klinička istraživanja dokazala su jasne koristi tjelesne aktivnosti za kardiovaskularno, ali i opće zdravlje svakoga čovjeka. Tjelesna aktivnost izaziva fiziološki odgovor organizma koji dovodi do različitih prilagodba pojedinih organskih sustava, a primjer jedne od njih jest i sportsko srce – benigni i reverzibilni odgovor kardiovaskularnog sustava na ponavljanu i intenzivnu tjelesnu aktivnost. Neke bolesti miokarda mogu dijeliti slične elektrokardiografske, ehokardiografske i druge karakteristike sa sportskim srcem. Pravodobno prepoznavanje takvih bolesti ključno je za zaštitu zdravlja svih koji se bave intenzivnijom tjelesnom aktivnosti rekreativno ili profesionalno.Numerous clinical studies have demonstrated obvious benefits of physical activity for cardiovascular, as well as general health of every human being. Physical activity induces a physiological response resulting in different adaptations of individual organ systems. One of such adaptations is the athlete\u27s heart representing a benign and reversible reaction of the cardiovascular system to repeated and intensive physical activity. Some of the myocardial diseases may share electrocardiographic, echocardiographic and other features similar to those of the athlete\u27s heart. Timely recognition of such diseases is crucial to the health of everyone who is engaged in a more intensive physical activity, either recreationally or professionally

Epigenetic drug 5-azacytidine impairs proliferation of rat limb buds in an organotypic model-system in vitro

Aim was to establish an organotypic in vitro model of limb bud development to verify whether epigenetic drug and teratogen 5-azacytidine (5azaC) has an effect on limb buds independent of its effects on the placenta. Fischer strain rat fore- and hindlimb buds were microsurgically isolated from 13 days old embryos and cultivated in vitro for two weeks at the air-liquid interface in Eagle's minimum essential medium (MEM) with 50% rat serum. 30 μmol of 5azaC was added to the fresh medium. Overall growth was measured by an ocular micrometer. Routine histology, immunohistochemical detection of the proliferating cell nuclear antigen (PCNA), and stereological quantification of PCNA expression were performed. RESULTS: At four time points, significantly lower overall growth was detected for fore- and hindlimb bud explants cultivated with 5azaC in comparison to controls. After the culture period, numerical density of the PCNA signal for both types of limb buds was lower than for controls (P<0.001). Limb buds were initially covered by immature epithelium and contained mesenchyme, myotubes, single hemangioblasts, hemangioblast aggregates, blood islands, and capillaries. Regardless of the treatment, cartilage and epidermis differentiated, but cells and structures typical for vasculogenesis disappeared. CONCLUSION: Our findings, obtained outside of the maternal organism, stress the importance of compromised cell proliferation for 5azaC impact on limb buds. This investigation points to the necessity to establish alternatives to in vivo research on animals using teratogenic agents

Exploring the relationship between smoking status and the total number of coronary arteries with significant stenoses in a young population with ST-segment elevation myocardial infarction

Background: A plethora of studies have proven the increase in cardiovascular risk associated with smoking in all age groups1, including the one at the focus of this study – the young2,3. With regard to the total number of coronary arteries (CA) with significant stenoses, one might expect current smokers to have more affected CA than non- and former smokers. Aim: To explore the relationship between smoking status and the total number of CA with significant stenoses in a young ST-segment elevation myocardial infarction (STEMI) population. Patients and Methods: Data were attained from medical records of 147 patients (mean age 43.9±6.5 years) hospitalized with STEMI at the University Hospital Centre Zagreb from January 2012 to October 2018, with a cut-off age at 45 years for men (n = 93) and 55 years for women (n = 54). Patients were divided in 2 groups based on smoking status – non- and former smokers (N = 29 (20%), with former smokers making up 9/29 or 31% of the group), and current smokers (N = 118 (80%)). To evaluate whether smoking status was associated with a higher total number of CA with significant stenoses, Pearson’s chi-squared test was performed. During post hoc testing, the p value was adjusted to maintain the familywise error rate at 0.05 (p = 0.008) and compared to p values of each subgroup. Results: The two groups had no significant differences in baseline characteristics (Table 1). In both groups, the majority of patients (58.6% vs. 74.6%) had only one affected CA, followed by two (27.6% vs. 19.5%) and three (13.8% vs. 5.9%) CA. Pearson’s chi-squared test showed no statistically significant difference in the total number of affected CA between the two groups (p = 0.176). Post hoc testing confirmed statistically insignificant associations in all subgroups (p > 0.008, Table 2). In multiple regression (F (2, 144) = 9.27, p < 0.001, R2 adjusted = 0.10), age (B = 0.03, p = 0.001) and family history for cardiovascular disease (B = 0.30, p = 0.003) remained associated with the number of affected CA