Acute lymphoblastic leukemia is the most common hematological malignancy at pediatric age. Cardiotoxicity holds the first place among the causes of morbidity and mortality in these patients. Anthracyclines are cytostatic drugs frequently associated with cardiotoxicity. Early diagnosis of cardiac impairment during the treatment of pediatric patients is extremely important, both for modulating future chemotherapy and for administering cardioprotective agents. Long term monitoring after chemotherapy helps to identify the risk of late cardiotoxicity among cancer survivors. There are several biomarkers, already in use or still under study, which may represent an operator-independent alternative for echocardiography in the diagnosis of cardiotoxicity. In case of cardiac damage, the clinician has options for treating or limiting the progression, either with the use of already approved agents, such as Dexrazoxane, or by administrating other cardioprotective drugs. International experts are still attempting to establish the best algorithm for early detection of cardiotoxicity, as well as the most efficient treatment plan in case of already existing myocardial damage in these patients. We present a review on treatment-related cardiotoxicity, including mechanisms of development, useful biomarkers and treatment options, after carefully analyzing specialty literature.
The international standard protocol for acute lymphoblastic leukaemia (ALL), the most common haemato-oncological pathology at paediatric age, uses anthracyclines as antitumor agents, potentially associated with early or late onset cardiac damage. Currently, echocardiography is the gold standard in the diagnosis of cardiotoxicity, but several biomarkers are evaluated as a possible replacement, pending more extensive clinical studies. We started a prospective study in order to determine the role of two biomarkers, troponin and heart-type fatty acid binding protein, in the evaluation of cardiotoxicity in children over one year of age, diagnosed with ALL. Between February 2015 and April 2016, 20 patients were enrolled and monitored at diagnosis, during chemotherapy and four months after the end of reinduction, through cardiac evaluation and dosing of those two markers in five different points of the treatment protocol. During the first year of follow-up, the patients did not develop clinical signs of cardiac damage, but the study showed a slight increase in troponin levels during chemotherapy, with the return to baseline value after treatment cessation, and also a correlation with the total dose of anthracyclines given to the patient. On the other hand, the second biomarker, heart-type fatty acid binding protein, did not seem to be useful in detecting subclinical cardiac damage in these patients.
Cardiac abnormalities are frequently reported in acute subarachnoid hemorrhage (SAH) patients. However, frank ST-elevation and myocardial dysfunction mimicking acute coronary syndrome is a rare occurrence. Systemic and local catecholamine release mediate myocardial injury and may explain raised troponin levels, concordant regional wall motion abnormalities and systolic dysfunction. These findings can pose a significant problem in the acute setting where “time-is-muscle” paradigm can rush clinicians towards a “rule-in” diagnosis of acute myocardial infarction.
We present the case of a 60-year-old male who arrived at a regional emergency department with loss of consciousness, chest pain and headache. His ECG showed ST-elevation in precordial leads with corresponding region wall motion abnormalities and dynamically elevated troponin levels which supported a diagnosis of acute myocardial infarction. Percutaneous coronary intervention was attempted but found no hemodynamically significant lesions and the patient was managed conservatively with antithrombotic treatment. Further work-up for his headache led to the diagnosis of aneurysmal SAH and subsequent endovascular coiling. The patient was discharged with a good clinical outcome. We discuss the potential catastrophic consequences of interpreting neurologic myocardial stunning as STEMI. Use of potent antithrombotic therapies, like bridging thrombolysis, in this setting can lead to dismal consequences. Clinical history should still be carefully obtained in the acute setting in this era of sensitive biomarkers.
Coronary heart disease occurs more often in patients over the age of 45. However, recent data shows a growing incidence of coronary events in younger patients also. Young patients with acute myocardial infarction (AMI) represent a relatively small proportion of subjects suffering from an acute ischemic event. However, they represent a subset that is distinguished from elderly patients by a different profile of risk factors, often atypical clinical presentation, and different prognosis. The prevalence of risk factors such as smoking, dyslipidemia, and a family history of coronary events is higher in this group of patients compared to the general population with AMI. Because of an important negative impact on the patients’ psychology, impaired working abilities, and a high socioeconomical burden, myocardial infarction in young patients represents an important cardiovascular pathology. This manuscript aims to present the particularities of AMI occuring at a young age, in comparison with the rest of the population with AMI.
Natural by-products from vegetable oil industries and spent edible oils from domestic or public food spaces should be recycled to obtain new added value products. Present paper proposed a technical solution for complete valorisation of inedible oilseeds or spent edible oils into bioproducts for nutrition and protection of plants cultivated in conservative organic agrosystems. Pressed cakes resulted from mechanical cold extraction of mustard oil contain residual oil and bioactive compounds which were released using an enzymatic cocktail 1:1 cellulase with proteases coupled with azeotropic solvents into a single Soxhlet extractor. From mustard meal, a solid fraction with glycerol derivatives of fatty acids (56.23% oleate and 17.47% linoleate) decanted from syrup (41.78% xylopyranoside and 48.48% trilinolein) and from mustard cake (76.44% linoleate) in the supernatant, the same oligosaccharide (29.64%) and proteinates (30.18%) in the solid fraction. The total extract was simultaneously concentrated and converted into a bioactive potassium salt emulsion able to encapsulate insectofungicidal natural compounds as bioproducts with agronomical applications.
This paper discusses the synthesis of a glycerol ketal compound obtained from condensation reaction of cyclohexanone with glycerol catalyzed by a solid superacid. The solid superacid SO42-/TiO2-La2O3 was prepared using coprecipitation and impregnation method and characterized by X-ray diffraction, thermogravimetric analysis, Fourier transform infrared spectroscopy and elemental analysis. The surface acidity was measured by thermogravimetric analysis of adsorbed n-butylamine. In order to achieve the optimal reaction conditions, five impact factors: molar ratio of glycerol to cyclohexanone, catalyst calcination temperature, reaction time, catalyst amount and molar ratio of Ti/La were investigated in the experiments. Synthesized ketal compounds were analyzed by GC-MS/MS. Under the best conditions, the cyclohexanone glycerol ketal yield could reach up to 97%.
Introduction: Extrahepatic portal vein thrombosis (EPVT) is the most frequent cause that leads to portal hypertension in non-cirrhotic patients. This condition is related to systemic and local risk factors (such as inflammatory lesions, injuries to portal venous system by surgery, vascular procedures).
Case presentation: A case of extended extrahepatic portal vein thrombosis and simultaneous thrombosis of left common iliac vein and inferior vena cava, appeared after abdominal surgery in a hypertensive, diabetic, 50 y.o. man is presented. An acute episode of abdominal pain was interpreted as an emergency and a surgical (initially laparoscopic and then open) procedure was planned in order to perform an appendectomy. Discharge diagnosis was hemoperitoneum secondary to iatrogenic rupture of sigmoid mesocolon provoked by trocar manipulation. Repeated imaging studies performed later revealed the thrombosis of portal vein with extension into right portal branch associated with superior mesenteric thrombosis and free-floating thrombus into left common iliac vein extended towards inferior vena cava. Surgical manoeuvres are considered as triggers of these thrombotic events. After 4 weeks of parenteral anticoagulation a partial recanalization of thrombi was identified, without bleedings.
Conclusions: Acute EPVT needs a carefully management. Case is linked to abdominal surgery and requires prolonged anticoagulation related to simultaneous portal and iliac vein thrombosis. Associated conditions (hypertension and diabetes mellitus) must have an appropriate approach. After our knowledge this is the first case published in literature.
Aim: The present study aim to analyze the relationship between GST M/T genotypes of glutathione S-transferases and cervical intraepithelial neoplasia.
Materials and Methods: A prospective case-control study has been designed including 69 cases with different degrees of cervical dysplasia and 107 controls. All patients had been examined colposcopically. For every patient both cervical and blood specimen have been obtained. The peripheral blood was used for GST M/T genotyping. The statistical analysis was performed using OR and chi-square at a level of significance inferior to 0.05.
Results: No statistically significant differences had been found between cases and controls for GST T-/M- geno-type (T-/M-, χ2=0.03, p= 0.8610) and T+/M+ χ2=0.65, p = 0.4197. Patients with in situ carcinoma had significant GST genotype association for T-/M+ genotype (OR=4.66, CI 95% [0.6528,24.9725], χ2=4.6, p=0.0314) and for T+/M- genotype (OR=0.12, CI 95% [0.0027,0.9465], χ2=0.05, p=0.0219).
Conclusion: The combination of GST genotypes can be included in a predictive score for patients with cervical carcinoma.
Background: Numerous studies discuss the protective effects of halogenated anesthetics on myocyte injury induced by the ischemia-reperfusion syndrome of the heart. This mechanism is known as pharmacological preconditioning.
Aim of the study: The objective of this study was to identify the effects of two volatile anesthetics frequently used in current clinical practice, Isoflurane and Sevoflurane, on the in situ heart. The study was performed on laboratory animals with induced brain death.
Material and methods: The animals were divided into 3 groups, the control group (n = 8), IZO-PRE group (n = 8) and SEVO-PRE group (n = 8), on which the experimental protocol established for this study was applied. From a molecular point of view, the expressions of protein kinase C-epsilon (PKCε) and of glycogen synthase kinase – 3 beta (GSK-3β) were investigated.
Results: Following the statistical analysis, we observed a significant reduction in the size of the infarcted area in the IZO-PRE group compared to the control group (p <0.0001). Regarding the SEVO-PRE group, no reduction was observed (p >0.05). The expression of GSK-3β is more pronounced in case of the SEVO-PRE group, at 5 minutes after reperfusion, and the effect disappears after 15 minutes. The expression of PKCε as a total form of the enzyme, occurs at 5 minutes after reperfusion in the SEVO-PRE group and late in the IZO-PRE group (after 15 minutes).
Conclusions: Both anesthetics that were applied showed a cardioprotective effect. Isoflurane provided a better structural and morphological protection, but Sevoflurane resulted in a more effective protection in terms of functionality, significantly reducing the incidence of extremely severe life-threatening arrhythmias.
The management of the critically ill polytrauma patient is complex due to the multiple complications and biochemical and physiopathological imbalances. This happened due to the direct traumatic injury, or due to the post-traumatic events. One of the most complex physiopathology associated to the multiple traumas is represented by microvascular damage, subsequently responsible for a series of complications induced through the imbalance of the redox status, severe molecular damage, reduction of the oxygen delivery to the cell and tissues, cell and mitochondrial dead, augmentation of the inflammatory response and finally the installation of multiple organ dysfunction syndrome in this type of patients. A gold goal in the intensive care units is represented by the evaluation and intense monitoring of the molecular and physiopathological dysfunctions of the critically ill patients. Recently, it was intensely researched the use of microRNAs as biomarkers for the specific physiopathological dysfunctions. In this paper we wish to present a series of microRNAs that can serve as biomarkers for the evaluation of microvascular damage, as well as for the evaluation of other specific physiopathology for the critically ill polytrauma patient.