Romheld's Gastrocardiac Syndrome, diagnosing a complex of cardiologic and gastroenterologic symptoms

In clinical practice among cardiac patients, symptoms of palpitations diagnosed as premature beats or episodes of atrial fibrillation (AF) are very frequently reported. One of the most common diseases in the field of gastroenterology is gastroesophageal reflux disease (GERD) . However, it may happen that the coincidence of the above-mentioned disease entities may predispose to the development of arrhythmias. In this article we describe the case of a 65-year-old man, without previously diagnosed diseases, in whom a clear association of arrhythmias with gastrointestinal complaints was observed. The presence of a burning sensation in the lower sternal region and typical symptoms resulting from esophagitis aggravated by triggers allows us to suspect esophageal reflux disease. Diagnostic tests performed for concomitant cardiac diseases did not reveal an organic cause of the arrhythmia. The recurrent course of symptoms observed in the present case and the analysis of the cause-effect course made us to diagnose gastrointestinal syndrome, also referred to as Romheld's Syndrome

Anemia amongst patients with heart failure - a review

Introduction Anemia and iron deficiency are common comorbidities in population with heart failure. Their association with unfavorable prognostic outcomes and diminished quality of life underscores the imperative need for accurate diagnosis and efficacious treatment interventions. In recent years numerous treatment options have been explored in clinical trials, aimed at addressing the multifaced aspects of these concurrent conditions. Summary In patients with heart failure effective treatment of anemia and iron deficiency has demonstrated enhancements in quality of life and exercise capacity. Findings from IRONMAN clinical study have prompted revisions in the latest guidelines from the European Society of Cardiology. The imminent release of results from two ongoing trials holds the potential to reshape the therapeutic landscape for treating individuals with heart failure and iron deficiency. Nevertheless, there is no explicit evidence that studied interventions could improve morbidity or risk of hospitalizations

The impact of physical activity on the risk and severity of COVID-19 infection

Introduction: A rapid outbreak of SARS-CoV-2 in the past few years caused a significant increase in the number of upper respiratory tract infections throughout the world. Numerous public health institutions tried to control the COVID-19 pandemic, including mandatory mask wearing, vaccinations, increased frequency of using disinfectants or compulsory lockdowns. Lockdown interventions were necessary, although they lead to insufficient, comparing to the international recommendations, levels of physical activity, which could trigger an elevated susceptibility to diseases of affluence. Purpose: Regular aerobic exercise may suppress inflammation, boost innate immunity and result in enhanced protection against viral infections. This review aims to show the relationship between level of physical activity and the risk and severity of COVID-19 infectio

Microvascular angina – an abstruse path to diagnose and to treat – a review of literature

Introduction: Chronic coronary syndrome is predominantly related to the atherosclerotic obstruction of the coronary artery or arteries. However, this phenomenon is not the only causative factor in this disease. It is usually forgotten, that there is a possibility of ischemia of the cardiac muscle with no obstruction found in the main vessel. The trigger of such pathology might be underlying in the microcirculatory system and the inappropriate dilation or constriction of those small vessels, which results in insufficient blood supply to the cardiomyocytes, similarly to the typical obstructive coronary artery disease. In this article we are willing to show that such dysfunction poses a great danger to the health and life and therefore we should be able to properly diagnose and treat it. Purpose of the work: The aim of this review of up-to-date literature is to raise awareness among both doctors and patients about the phenomenon of coronary artery disease but with no significant obstruction in the vessels supplying the cardiac muscle. The common cause of such condition is coronary microvascular dysfunction, that leads to a disease called microvascular angina. Our purpose was to reveal, how dangerous to the health of the patients this could be and therefore how essential it is to provide a proper diagnose and management. In addition, we have noticed a need for a summary of what has already been discovered on this topic, available therapeutic methods and future perspectives

How to deal with pain in the emergency department - pain management review

One of the primary health issues bringing patients to hospital emergency rooms is pain. It is often treated inadequately. Doctors working in the emergency department have the option of using a number of drugs for analgesia. The three main groups include non-steroidal anti-inflammatory drugs, non-opioid analgesics and opioid analgesics. In order to properly exploit their potential, it is necessary to properly classify the pain, know the basic action of the available drugs, choose the right dose, and know how to combine drugs from different groups to achieve balanced analgesia. By acting in this way, the patient in the hospital emergency department will be properly provided with medication, and this will have a positive effect on his overall health

Charakterystyka modeli in vitro do badań nad rakiem jajnika

W leczeniu onkologicznym coraz większą rolę odgrywają leki celowane molekularnie. W terapii raka jajnika najbardziej obiecujące wyniki daje zastosowanie leków z grupy inhibitorów polimerazy poliADP-rybozy (PARP). Badania kliniczne ostatnich lat wykazały, że inhibitory PARP stosowane w terapii podtrzymującej wydłużają czas wolny od progresji o wiele miesięcy. To zachęca do poszukiwania kolejnych leków celowanych i stwarza nadzieję, że rak jajnika może się stać chorobą przewlekłą, o wieloletnim przebiegu.Problemem w badaniach nad rakiem jajnika jest heterogenność choroby. Ostatnie badania wskazują, że różne typy histologiczne mogą mieć odrębne pochodzenie tkankowe. Według współczesnej wiedzy określenie „rak jajnika” jest sztucznym pojęciem, obejmującym różne inwazyjne raki zlokalizowane w obrębie miednicy. Badania genetyczne i immunofenotypowe wskazują, że niskozróżnicowany rak surowiczy, najczęstszy i najgorzej rokujący typ histologiczny, w większości przypadków wywodzi się z nabłonka jajowodu, raki endometrioidalne i jasnokomórkowe wywodzą się zaś prawdopodobnie z endometrium. Dlatego w badaniach podstawowych i przedklinicznych nad rakiem jajnika potrzebne są dobrze scharakteryzowane modele odpowiadające poszczególnym typom histologicznym.W niniejszej pracy omówiono najczęściej wykorzystywane linie komórkowe stosowane w badaniach in vitro. Opracowanie ma na celu podsumowanie zalet i ograniczeń różnych modeli, obejmujących hodowle pierwotne i stabilne linie komórkowe, model hodowli dwu- i trójwymiarowej itp. W szczególności autorzy chcą zwrócić uwagę badaczy, że najczęściej stosowane linie komórkowe SKOV3 i A2780 nie są właściwym modelem do badań nad niskozróżnicowanym rakiem surowiczym

Fibronectin and Periostin as Prognostic Markers in Ovarian Cancer

Previously, based on a DNA microarray experiment, we identified a 96-gene prognostic signature associated with the shorter survival of ovarian cancer patients. We hypothesized that some differentially expressed protein-coding genes from this signature could potentially serve as prognostic markers. The present study was aimed to validate two proteins, namely fibronectin (FN1) and periostin (POSTN), in the independent set of ovarian cancer samples. Both proteins are mainly known as extracellular matrix proteins with many important functions in physiology. However, there are also indications that they are implicated in cancer, including ovarian cancer. The expression of these proteins was immunohistochemically analyzed in 108 surgical samples of advanced ovarian cancer (majority: high-grade serous) and additionally on tissue arrays representing different stages of the progression of ovarian and fallopian tube epithelial tumors, from normal epithelia, through benign tumors, to adenocarcinomas of different stages. The correlation with clinical, pathological, and molecular features was evaluated. Kaplan–Meier survival analysis and Cox-proportional hazards models were used to estimate the correlation of the expression levels these proteins with survival. We observed that the higher expression of fibronectin in the tumor stroma was highly associated with shorter overall survival (OS) (Kaplan–Meier analysis, log-rank test p = 0.003). Periostin was also associated with shorter OS (p = 0.04). When we analyzed the combined score, calculated by adding together individual scores for stromal fibronectin and periostin expression, Cox regression demonstrated that this joint FN1&POSTN score was an independent prognostic factor for OS (HR = 2.16; 95% CI: 1.02–4.60; p = 0.044). The expression of fibronectin and periostin was also associated with the source of ovarian tumor sample: metastases showed higher expression of these proteins than primary tumor samples (χ2 test, p = 0.024 and p = 0.032). Elevated expression of fibronectin and periostin was also more common in fallopian cancers than in ovarian cancers. Our results support some previous observations that fibronectin and periostin have a prognostic significance in ovarian cancer. In addition, we propose the joint FN1&POSTN score as an independent prognostic factor for OS. Based on our results, it may also be speculated that these proteins are related to tumor progression and/or may indicate fallopian–epithelial origin of the tumor

Charakterystyka modeli in vitro do badań nad rakiem jajnika

Nowadays, targeted therapy plays a growing role in oncological treatment. In ovarian cancer, particularly promising results are achieved with poly (ADP-ribose) polymerase (PARP) inhibitors. Recent clinical trials have shown that PARP inhibitors can result in significantly longer progression-free survival. These results encourage the search for other targeted therapies and bring hope that ovarian cancer can soon become a manageable chronic disease. The main problem in ovarian cancer research is the heterogeneity of this disease. Recent studies have shown that different histological types of ovarian cancer can originate from distinct tissues. According to the recent knowledge, “ovarian cancer” is an artificial term for distinct invasive malignancies localised within the pelvis. Genetic and immunophenotype analyses have shown that high-grade serous ovarian cancer, the most frequent histological type and the one with the worst prognosis, originates mainly from fallopian tube epithelium, while endometrioid and clear-cell cancers originate from the endometrium. For these reasons, in basic and preclinical studies on ovarian cancer, one has to carefully choose a well-defined model system, corresponding to the histological type of interest. In this article, we discuss ovarian cancer cell lines most frequently used in in vitro studies. Our aim is to indicate the advantages and disadvantages of different models, encompassing primary and established cell cultures, two- and three-dimensional models, etc. In particular, we would like to alert researchers to the fact that the most popular cell lines SKOV3 and A2780 do not represent a suitable model for studies on high-grade serous ovarian cancer.Coraz większą rolę w leczeniu onkologicznym odgrywają leki celowane molekularnie. W terapii raka jajnika najbardziej obiecujące wyniki daje zastosowanie leków z grupy inhibitorów polimerazy poliADP-rybozy (PARP). Badania kliniczne ostatnich lat wykazały, że inhibitory PARP stosowane w terapii podtrzymującej wydłużają czas wolny od progresji o wiele miesięcy. To zachęca do poszukiwania kolejnych leków celowanych i stwarza nadzieję, że rak jajnika może się stać chorobą przewlekłą, o wieloletnim przebiegu. Problemem w badaniach nad rakiem jajnika jest heterogenność choroby. Ostatnie badania wskazują, że różne typy histologiczne mogą mieć odrębne pochodzenie tkankowe. Według współczesnej wiedzy, określenie „rak jajnika” jest sztucznym pojęciem obejmującym różne inwazyjne raki zlokalizowane w obrębie miednicy. Badania genetyczne i immunofenotypowe wskazują, że niskozróżnicowany rak surowiczy, najczęstszy i najgorzej rokujący typ histologiczny, w większości przypadków wywodzi się z nabłonka jajowodu, zaś raki endometrioidalne i jasnokomórkowe wywodzą się prawdopodobnie z endometrium. Dlatego, w badaniach podstawowych i przedklinicznych nad rakiem jajnika potrzebne są dobrze scharakteryzowane modele odpowiadające poszczególnym typom histologicznym. W niniejszej pracy omówiono najczęściej wykorzystywane linie komórkowe stosowane w badaniach in vitro. Nasze opracowanie ma na celu podsumowanie zalet i ograniczeń różnych modeli, obejmujących hodowle pierwotne i stabilne linie komórkowe, model hodowli dwu- i trójwymiarowej. W szczególności pragniemy zwrócić uwagę badaczy, że najczęściej stosowane linie komórkowe SKOV3 i A2780, nie są właściwym modelem do badań nad niskozróżnicowanym rakiem surowiczym

Characteristics of in Vivo Model Systems for Ovarian Cancer Studies

An understanding of the molecular pathogenesis and heterogeneity of ovarian cancer holds promise for the development of early detection strategies and novel, efficient therapies. In this review, we discuss the advantages and limitations of animal models available for basic and preclinical studies. The fruit fly model is suitable mainly for basic research on cellular migration, invasiveness, adhesion, and the epithelial-to-mesenchymal transition. Higher-animal models allow to recapitulate the architecture and microenvironment of the tumor. We discuss a syngeneic mice model and the patient derived xenograft model (PDX), both useful for preclinical studies. Conditional knock-in and knock-out methodology allows to manipulate selected genes at a given time and in a certain tissue. Such models have built our knowledge about tumor-initiating genetic events and cell-of-origin of ovarian cancers; it has been shown that high-grade serous ovarian cancer may be initiated in both the ovarian surface and tubal epithelium. It is postulated that clawed frog models could be developed, enabling studies on tumor immunity and anticancer immune response. In laying hen, ovarian cancer develops spontaneously, which provides the opportunity to study the genetic, biochemical, and environmental risk factors, as well as tumor initiation, progression, and histological origin; this model can also be used for drug testing. The chick embryo chorioallantoic membrane is another attractive model and allows the study of drug response

Microfibril Associated Protein 5 (MFAP5) Is Related to Survival of Ovarian Cancer Patients but Not Useful as a Prognostic Biomarker

Ovarian cancer (OC) is usually diagnosed late due to its nonspecific symptoms and lack of reliable tools for early diagnostics and screening. OC studies concentrate on the search for new biomarkers and therapeutic targets. This study aimed to validate the MFAP5 gene, and its encoded protein, as a potential prognostic biomarker. In our previous study, we found that patients with high-grade serous OC who had higher MFAP5 mRNA levels had shorter survival, as compared with those with lower levels. Here, we used the Kaplan-Meier Plotter and CSIOVDB online tools to analyze possible associations of MFAP5 expression with survival and other clinico-pathological features. In these analyses, higher MFAP5 mRNA expression was observed in the more advanced FIGO stages and high-grade tumors, and was significantly associated with shorter overall and progression-free survival. Next, we analyzed the expression of the MFAP5 protein by immunohistochemistry (IHC) in 108 OC samples and tissue arrays. Stronger MFAP5 expression was associated with stronger desmoplastic reaction and serous vs. non-serous histology. We found no significant correlation between IHC results and survival, although there was a trend toward shorter survival in patients with the highest IHC scores. We searched for co-expressed genes/proteins using cBioPortal and analyzed potential MFAP5 interaction networks with the STRING tool. MFAP5 was shown to interact with many extracellular matrix proteins, and was connected to the Notch signaling pathway. Therefore, although not suitable as a prognostic biomarker for evaluation with a simple diagnostic tool like IHC, MFAP5 is worth further studies as a possible therapeutic target