Chronic Lymphocytic Leukemia — Microenvironment and B Cells

Chronic lymphocytic leukemia (CLL) has been considered as an accumulative disease deriving from defects in apoptosis, but recent studies showed that CLL is a dynamic process in which monoclonal B cells proliferate within pseudofollicular proliferation centers. Microenvironmental interactions are essential for the survival and proliferation of CLL cells. The cell traffic between blood and secondary lymphoid tissues is controlled by tissue-specific chemokines and their specific receptors on B lymphocytes. Interstitial cell migration and adhesion events, predisposed by activational stimuli, determine CLL cell localization. Stimulation through the B cell receptor plays an important role in the expansion of the malignant clone in CLL. B cell receptors become activated either in an antigen-dependent or in an antigen-independent fashion in the secondary lymphatic tissues. However, low expression of the BCR correlates with reduced induction of protein tyrosine kinase activity and defective intracellular calcium mobilization and tyrosine phosphorylation. In contrast to normal B cells, leukemic cells are poor antigen presenting cells. This is due to the fact that leukemic cells have a reduced expression of costimulatory molecules and defects in the formation of immunological synapse with T cells. Increased surface expression of the costimulatory molecules on CLL cells correlates with their proliferation. At present, conventional treatments are not directed to interactions between CLL cells and their microenvironment, which is probably one of the reasons why, despite the significant progress in treatment, the disease still remains incurable. In this regard, identifying key biomarkers of intercellular interactions of neoplastic CLL population in comparison with clinical laboratory abnormalities in CLL enable clarification of essential processes in the development of the disease, and can be the basis for stratifying patient groups in order to optimize therapeutic approaches, which will make them relevant and promising

Colorectal resections - clinical and immunological results

INTRODUCTION: Surgery induces a generalized state of postoperative immunosuppression responsible for a lot of complications in postoperative period. Magnitude and type of the intraoperative injury depend on the extent and duration of postoperative immune suppression. This study compared clinical outcomes and immune changes after minimally invasive and open colorectal resections in patients with colorectal cancer (CRC).MATERIAL AND METHODS: Study included 40 patients with CRC who underwent colorectal resections in our clinic last year. Twenty one of them underwent minimally invasive surgery, with a mean age of 64.8 years (49-86). The rest 19 patients underwent conventional surgery, with a mean age of 66.2 years (56-84). Blood tests were performed 24 hours prior to surgery, 24 hours and 7 days after surgery. Analysis included full blood count, total protein, albumin and markers of inflammation (CRP, ESR, fibrinogen). T- (CD3+), B- (CD19+) and NK-cell lymphocyte populations were studied by means of flow cytometry, as well as activation of leucocytes, according to the expression of HLA-DR, CD38, CD279, CD163 and some clinical parameters. All data were analyzed using SPSS version 21.RESULTS: There was no significant difference in preoperative results between minimally invasive group and conventional group. At 24 hours after surgery there were significant decrease in lymphocyte percentages and increased leucocyte count, granulocyte percentages and CRP levels in conventional group. This ratio maintained at 7 days after surgery. Activated monocyte (CD 163+), total protein and albumin, eosinophiles, percentage of monocytes, lymphocytes and NKT-cells (CD3+ CD16/CD56+) were significant decrease in conventional group compared with minimally invasive group at first postoperative day.CONCLUSIONS: Minimally invasive colorectal cancer resection is a technically feasible option, with comparable results in terms of oncologic clearance, lesser degrees of tissue injury, surgical metabolic stress, and immunosuppressive response to conventional open surgery. Patients undergoing minimally invasive resections demonstrated improved clinical recovery and shorter hospital stay than patients undergoing open surgery. 

Bipolar affective disorder, pregnancy and childbirth: clinical characteristics and heredity

Bipolar affective disorder has higher frequency among women of reproductive age and can relapse both during pregnancy and immediately after childbirth. The presence of family history is one of the leading risk factors for bipolar affective disorder. A cross-sectional study was performed as part of a large naturalistic study. It included 81 women with pronounced symptoms of bipolar disorder who required hospitalization. The clinical method included comprehensive assessment of patients in the cohort, assessment of the severity of symptoms and the family history. The results showed that more than 50% of the women were at an average age of 25 years and experienced bipolar affective disorder mostly in the first and third trimester, whereas, in the puerperal period, the risk was highest in the first two weeks after childbirth. There was previous history of bipolar affective disorder in about 50% of the women. In 55.6% of the women, there was family history of bipolar affective disorder. The presence of previous history of bipolar affective disorder, first-degree family history and pregnancy at later age were shown to be risk factors for a new relapse during pregnancy and after childbirth. Clinical expression of manic–psychotic symptoms was more typical of the period of lactation than manic symptoms, which were associated rather with younger age and the period of pregnancy. In the studied cohort of patients, the risk of repeatability of affective episodes was significantly higher with each subsequent pregnancy