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Meandry diagnostyki i terapii pacjenta z rakiem żołądka i zawałem serca
Get PDFThe article presents the case of a patient with unresectable gastric cancer who received tislelizumab. After about a year of initiating treatment, acute coronary syndrome occurred. The case shows that before using tislelizumab, it is worth assessing the patient’s total cardiovascular risk.W artykule przedstawiono przypadek pacjenta z nieresekcyjnym rakiem żołądka, u którego zastosowano tislelizumab. Po około roku od włączenia leczenia wystąpił ostry zespół wieńcowy. Przypadek pokazuje, że przed zastosowaniem tislelizumabu warto ocenić całkowite ryzyko sercowo-naczyniowe chorego
Surgical treatment for acute pancreatitis and pancreatic necrosis
Get PDFPancreatitis, considered by clinicians to be one of the most serious abdominal disorders, is a life-threatening disease resulting in numerous complications if not diagnosed early or treated with special care. Management is based on supportive care, including rehydration, pain control, continuous monitoring of vital signs and assessment of organ function, and on early oral feeding. However, there are cases such as acute gallstone pancreatitis, necrotising pancreatitis, or acute fulminant (haemorrhagic) pancreatitis, that require operative or surgical intervention. As recent years have seen increasing numbers of different types and subtypes of pancreatitis, the guidelines concerning the most effective therapeutic methods, including invasive treatment, have evolved. The aim of this review was to present surgical treatment of acute pancreatitis (AP) in the light of changing patterns of management
Mechanisms of alleviating sepsis-induced rat lung and kidney damage by inhibiting expression of miRNA-939
No full textIntroduction. Sepsis, a life-threatening condition caused by a host response that goes out of control, leads to severe organ dysfunction. MicroRNA 939 (miRNA-939) plays a pivotal role in this process by post-transcriptionally regulating the mRNA expression of key enzymes in the NO/cGMP pathway. This pathway is crucial in the development of refractory hypotension and organ failure in sepsis. The aim of the study was to explore the effects of miRNA-939 on a caecum ligation puncture (CLP) rat model of sepsis in kidneys and lungs in order to elucidate its role in modulating the NO/cGMP pathway and related organ protection mechanisms.
Material and methods. To explore the effects of miRNA-939 on sepsis, three groups of rats were established: a sham surgery group, a sepsis model group, and an intervention group treated with LNA-antimiR targeting miRNA-939, which was administered via tail vein injection (the locked nucleic acid (LNA) group). miRNA-939 levels in serum, kidneys, and lungs were assessed using reverse transcription–polymerase chain reaction (RT-PCR). The protein levels of inducible nitric oxide synthase (iNOS) and soluble guanylate cyclase (sGC) were quantified using Western blotting. Serum nitric oxide (NO) levels were determined using the nitrate reductase method.
Results. Compared to the sham group, the rats in the sepsis model group exhibited significantly elevated levels of miRNA-939 in serum, with distinct peaks at 12, 24, and 36 h post-sepsis induction. Similarly, the protein levels of iNOS and sGC (sGCα1 and sGCβ1 subunits) in kidneys and lungs were markedly higher in the sepsis group. Serum NO levels were also significantly elevated in the sepsis group compared to the sham group. Importantly, inhibition of miRNA-939 in the LNA group led to a significant reduction in the tissue levels of iNOS, sGCα1, sGCβ1, and serum NO within the NO/cGMP pathway, alongside mitigating inflammatory damage to kidneys and lungs.
Conclusions. Inhibiting miRNA-939 significantly reduces the expression of iNOS, sGCα1, sGCβ1, and NO in the NO/cGMP pathway in CLP-exposed rats, thereby alleviating inflammatory organ damage in sepsis. These findings highlight the therapeutic potential of targeting miRNA-939 in the management of sepsis-induced organ dysfunction
Intracoronary adrenaline for the treatment of refractory no-reflow phenomenon: A single-centre experience
No full textSpinal cord stimulation in the treatment of refractory angina pectoris: 25-year clinical experience at a single center
No full textWhat treatment should be used in patients with advanced breast cancer progressing during hormone therapy combined with a cyclin-dependent kinase 4/6 inhibitor?
No full textThe standard of 1st or 2nd line palliative systemic therapy in patients with breast cancer expressing hormone receptors without overexpression of HER2 is the combination of hormone therapy (HT) with a cyclin-dependent kinase inhibitor 4/6 (CDK4/6i). Palbociclib, ribociclib, and abemaciclib in combination with an aromatase inhibitor (AI) or fulvestrant significantly prolong progression-free survival (PFS) compared to HT alone. Moreover, the addition of abemaciclib to fulvestrant and ribociclib to fulvestrant or an aromatase inhibitor prolongs overall survival (OS). Importantly, the combined therapy is characterized by a preferable toxic profile. Unfortunately, in the case of progression during HT in combination with CDK4/6i, the available drugs do not give such spectacular results in terms of efficacy or toxicity profile. In patients progressing during treatment with CDK4/6i in combination with a nonsteroidal aromatase inhibitor not selected for predictive factors for targeted therapy or in the absence of such factors, another line of HT (switching to fulvestrant or exemestane), or chemotherapy should be used. Both treatment strategies have a similar effect on prognosis. Combining another CDK4/6i or everolimus with HT slightly improves its effectiveness but is associated with additional toxicity. In patients with the ESR1 mutation, elacestrant is significantly more effective compared to fulvestrant. In patients with the PIK3CA mutation, alpelisib or capivasertib in combination with fulvestrant can be used. In patients with a germline BRCA1/2 mutation, a PARP inhibitor (PARPi, talazoparib, olaparib) prolongs PFS compared to chemotherapy without affecting OS. In patients with progression during treatment with the combination of CDK4/6i and fulvestrant, chemotherapy, exemestane, or abemaciclib can be used. Elacestrant and PARPi are indicated in patients with corresponding mutations. In patients progressing after previous HT and palliative chemotherapy, the efficacy of conjugates of antibody and a cytotoxic drug (sacituzumab govitecan; trastuzumab deruxtecan in HER2-low patients) has been demonstrated
Calcitonin and procalcitonin measurement after cholecystokinin-2/gastrin receptor agonist stimulation in patients with advanced medullary thyroid cancer: results from the GRAN-T-MTC study
No full textIntroduction: Medullary thyroid cancer (MTC) is characterized by overexpression of cholecystokinin-2/gastrin receptors (CCK2R). There are limitations of calcitonin as a tumor marker in MTC diagnosis and prognosis. Procalcitonin is gaining a role as a complementary tumor marker. This study aimed to assess the feasibility of procalcitonin measurements on top of the calcitonin measurements after CCK2R agonist stimulation in patients with MTC.
Material and methods: The assessment was part of the GRAN-T-MTC translational study conducted through a Phase I multicenter clinical trial in patients with locally advanced and/or disseminated MTC. Patients were administered intravenously the CCK2R agonist CP04 labelled with indium-111 ([111In]In-CP04); the first four patients at a lower mass amount of 10 μg, and afterwards the whole group at a higher mass amount of 50 μg. Blood samples for calcitonin and procalcitonin measurements were obtained shortly before and 2, 5, 10, and 20 minutes after start of [111In]In-CP04 administration.
Results: Sixteen patients were included in the study. After injection of the higher mass amount of [111In]In-CP04, the median maximum ratio for stimulated calcitonin was 2.97 (interquartile range [IQR] 2.35) pg/mL and procalcitonin 2.01 (IQR 2.07) pg/mL. The maximum stimulated/baseline calcitonin ratio was 5.2 ± 4.0 and 4.1 ± 3.8 in the low and high mass amount groups, respectively, and the maximum stimulated/baseline procalcitonin ratio was 4.6 ± 5.1 and 2.9 ± 3.1 in the low and high mass amount groups, respectively. There was a significant linear correlation between calcitonin and procalcitonin concentrations (p < 0.001) at each test time point and between the maximum procalcitonin and maximum calcitonin increment ratio (r = 0.94, p < 0.0001). Mild, short-lasting side effects (transient tachycardia, flushing) were observed in one patient during the injection of low and in two patients during the injection of high mass amount of [111In]In-CP04. The side effects were not related to the baseline calcitonin or procalcitonin concentrations.
Conclusion: Procalcitonin concentrations after CP04 stimulation were highly correlated with calcitonin concentrations. Unlabeled CP04, if available commercially, may be considered an alternative stimulating agent in MTC patients, even in lower mass amounts. Further studies, including healthy controls, are required to prove this concept and calculate the diagnostic thresholds
Dieta śródziemnomorska — jedna linia obrony przed chorobami układu krążenia i zwyrodnieniem plamki żółtej związanym z wiekiem
No full textIn recent years, life expectancy has increased. Advanced age is a major risk factor for the development of chronic dise-ases, such as cardiovascular diseases (CVD) and age-related macular degeneration (AMD), often associated with high costs of diagnosis, treatment, and care. Both CVD and AMD are among the most frequently diagnosed diseases in the elderly, which significantly reduce the quality of life of these patients, often leading to disability. Cardiovascular diseases are the leading cause of death worldwide, and AMD is the leading cause of blindness in adults. The prevalence of both diseases is expected to increase over the next decades. These diseases are not only linked by old age. Recently increa- sing evidence suggests that there are multiple similarities in the risk factors and pathogenic mechanisms of both AMD and CVD. Inflammation and oxidative stress have been associated with the development of CVD as well as with AMD. In addition, AMD is associated with an increased risk of CVD, cardiovascular, and overall mortality. For healthy aging disease prevention is more important than treatment and rehabilitation. Thus, the question arises whether the anti-inflammatory Mediterranean diet (MedDiet) could be another link between CVD and AMD as well as a single, common line of defense against AMD and CVD?
W ostatnich latach średnia długość życia wydłużyła się. Zaawansowany wiek jest głównym czynnikiem ryzyka rozwoju chorób przewlekłych, takich jak choroby układu krążenia (CVD, cardiovascular diseases) i zwyrodnienie plamki żółtej związane z wiekiem (AMD, age-related macular degeneration), które często są powiązane z wysokimi kosztami diagno- styki, leczenia i opieki. Zarówno CVD, jak i AMD są jednymi z najczęściej diagnozowanych chorób u osób starszych, które znacznie obniżają jakość życia tych pacjentów i często prowadzą do niepełnosprawności. Choroby sercowo-naczyniowe są główną przyczyną zgonów na świecie, a AMD jest główną przyczyną ślepoty u dorosłych. Oczekuje się, że częstość występowania obu wymienionych chorób wzrośnie w ciągu najbliższych dziesięcioleci. Choroby te są związane nie tylko z podeszłym wiekiem. W ostatnim czasie coraz więcej dowodów sugeruje, że istnieje wiele podobieństw w czynnikach ryzyka i mechanizmach patogenetycznych zarówno AMD, jak i CVD. Zapalenie i stres oksydacyjny zostały powiązane z rozwojem CVD, a także AMD. Ponadto AMD wiąże się ze zwiększonym ryzykiem CVD, śmiertelności z powodu chorób sercowo-naczyniowych i ogólnej śmiertelności. Dla zdrowego starzenia się zapobieganie chorobom jest ważniejsze niż leczenie i rehabilitacja. W związku z tym pojawia się pytanie, czy mająca działanie przeciwzapalne dieta śródziemnomorska może być kolejnym ogniwem łączącym CVD i AMD, a także wspólną linią obrony przed AMD i CVD?
XVII International Conference of the Journal Palliative Medicine in Practice Following the 19th EAPC Congress, the 30th Anniversary of the Department of Palliative Medicine of the Medical University of Gdańsk June 5–6, 2025, Gdańsk — Abstracts
No full textAssessment of cognitive impairment in Tunisian hypertensive patients
No full textBackground: The prevention of cognitive impairment is a major public health issue. Several international studies have shown a significant association between arterial hypertension (AH) and cognitive decline, highlighting the role of AH as a risk factor for dementia. Our aim was to evaluate cognitive impairment in hypertensive patients.
Material and methods: We conducted a descriptive, prospective, multicenter study involving patients over 40 years old with confirmed essential hypertension for more than 3 years. All participants underwent neuropsychological assessment using three tests exploring cognitive function: Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and Memory and Executive Screening (MES). Then, we divided our population into two groups: a group with cognitive decline defined by an MMSE score < 24 and no cognitive decline.
Results: We included 200 patients with a mean age of 65 ± 9 years and a gender ratio of 0.78. Assessment of cognitive performance revealed a cognitive decline in 42.5% of patients (n = 85) by MMSE, 73.5% of cases (n = 147) by MoCA, and 82.5% of cases (n = 165) by MES. The four factors independently predictive of cognitive decline were: age [odds ratio (OR) adjusted: 10.6, 95% confidence interval (CI): 4.38–23.57], p < 0.001), female sex (OR adjusted: 7.81, 95% CI: 3.15–19.29, p < 0.001), sedentary lifestyle (OR adjusted: 2,52, 95% CI: 1.09–5.86, p = 0.031) and poor blood pressure (BP) control (OR adjusted: 3.33, 95% CI: 1.35–5.86, p = 0.009).
Conclusion: Our study showed that cognitive impairment was frequent in hypertensive patients. Screening should be carried out to implement an appropriate therapeutic strategy