MIDDLE TERM IMPACT OF SLEEVE GASTRECTOMY ON MAJOR CARDIOVASCULAR RISK FACTORS IN A GROUP OF ROMANIAN OBESE PATIENTS.

BACKGROUND AND AIM: The goals of bariatric surgery are to improve the quality of life by lowering body mass index (BMI) but also to treat obesity comorbidities. The aim of our study was to evaluate the impact of laparoscopic sleeve gastrectomy (LSG) on metabolic parameters. METHODS: 85 obese patients treated by bariatric surgery LSG procedure were included in the study. Basal, 6 and 12 months after surgery serum glucose levels and lipid fractions were measured. Metabolic syndrome criteria according to IDF 2006 were evaluated at baseline and after bariatric surgery. RESULTS: Our group included 61.2 % female patients, the mean age was 40.2 ±10.2 years and the metabolic syndrome criteria at baseline were confirmed in 69.4% of the study group. At twelve months after the intervention, the mean excess weight loss (%EWL) was 72%, with age and BMI subgroups variations. We found significant improvements of serum concentrations for triglycerides (P-value = 0.001, decreased by 30%), HDL-cholesterol (P-value = 0.017, increased by 26%), total cholesterol (P-value = 0.043, decreased by 12%) and glucose (P-value = 0.007, decreased by 12%). CONCLUSIONS: The positive effect of bariatric surgery was confirmed for lipid fractions and fasting glucose levels, also the metabolic syndrome prevalence was significantly reduced, all these changes contribute to lower cardiovascular risk together with significant weight loss.

VITAMIN D AND TISSULAR EXPRESSION OF VITAMIN D RECEPTOR IN OBESITY.

Vitamin D (VitD), a lipid-soluble hormone, is able to regulate the transcription of many genes through vitamin D receptor (vitD receptor-VDR). It has been shown that VitD deficiency is associated with obesity, characterized by a low degree inflammatory state, which contribute to the pathogeny of metabolic syndrome and type 2 diabetes mellitus. VitD deficiency is a public health problem, at the same time the global prevalence of obesity and cardiovascular diseases is continuously growing. Evidence from recent studies on animal models suggest that VitD or VDR deficiency promotes cardiomyocyte hypertrophy, which can be one of the mechanisms for increasing cardiovascular risk. The heart is one of the target organs of action for VitD, because VDR is expressed in cardiomyocytes. Also, previous in vitro studies have shown that VitD is able to inhibit the production of monocyte chemotactic factors (MCP-1) and other pro-inflammatory mediators in human preadipocytes and mature adipocytes. Inflammation is an important factor in the pathogenesis of atherosclerosis. In obesity there are not known data about correlations between plasma levels of VitD and VDR expression in the subcutaneous fat tissue, epicardial visceral adipose tissue, and in particular in myocardium. Also, there are still no studies to test VDR expression in myocardial cells and to investigate the results of dietary VitD supplementation on the expression of VDR in the epicardial adipose tissue and myocardium.

CONCENTRATIONS OF VITREAL CYTOKINES IN RHEGMATOGENOUS RETINAL DETACHMENT.

UNLABELLED: Proliferative vitreoretinopathy (PVR) is one of the most frequent causes of failure of rhegmatogenous retinal detachment (RRD) surgery. AIM: To measure the vitreous levels of granulocyte colony stimulating factor (G-CSF) and monocyte chemoattractant protein 1 (MCP-1) in eyes with RRD and in a control group. MATERIAL AND METHODS: A prospective study of 40 patients operated for RRD (study group) and 20 patients with epiretinal membrane or macular holes (selected as control group since they needed vitrectomy but had attached retinas). Vitreous samples were collected during vitrectomy and were assessed for the presence of cytokines using a fluorescent bead-based multiplex assay. RESULTS: The concentration of G-CSF (8.59 pg/ml) and MCP-1 (1615.2 pg/ml) were significantly increased in the study group, when compared to the control group (0 and 469.13 pg/ml, respectively). MCP-1 was also significantly increased in the subgroup of patients with PVR compared to the patients with uncomplicated RRD. CONCLUSIONS: The levels of these biomarkers support the idea that proliferative vitreoretinopathy has an inflammatory component.

Current status in vitamin D and regulatory T cells--immunological implications.

There has been a continuous effort to understand possible non-Ca metabolism roles of vitamin D, including its role in the immune system and, in particular, in T cell-medicated immunity. Vitamin D receptor is found in significant concentrations in the T lymphocyte and macrophage populations, when we refer to immune system, and pretty much in any human tissue and cells. Until the eighties, no one had imagined that vitamin D might play a role in the functioning of the immune system. Today we accepted that the normal immune system harbors a regulatory T cell (Treg) population specialized for immune suppression. Currently, the most commonly known regulatory T-cell lineage is called CD4+ CD25high FoxP3+ regulatory T cells. Several autoimmune disorders have been linked to a deficiency in vitamin D3. In some autoimmune diseases, including multiple sclerosis (MS), a compromised Treg function is believed to be critically involved in the disease process. Vitamin D insufficiency has ramifications not only for bone health, but also in other non-skeletal areas of vitamin D function, such as immune cells, muscle cells and, perhaps, adipocytes. As a final conclusion, further researches in the field of vitamin D, Tregs, immunity (inflammatory processes, rejection, autoimmune diseases, etc.), either in vitro on cell cultures or in vivo using lab animals or volunteers are still necessary.

Laser microdissection--a novel approach for accessing the molecular basis of cancer.

BACKGROUND AND AIM: It has been known for quite a lot of time that tumours are cellular aggregates of different cells, mainly malignant cells but also immune cells--of which the most well-known are the tumour infiltrating lymphocytes (TIL) and the tumour associated macrophages (TAM). By observing hematoxylin--eosin stained or immunohistochemical stained slides belonging to different areas of the tumour it is clear that there are clusters of malignant cells within the tumour itself that seem to behave differently from the rest of the tumour. Another fact is that different areas of the tumour contain different inflammatory cells which may promote carcinogenesis or may help to confine it. Whereas different immune cells can be recognised by using immunohistochemistry, a satisfactory characterization of the molecular characteristics of the malignant clusters of the tumour cannot be made without further use of different molecular techniques such as different PCR techniques or microarray methods. Laser microdissection thus comes as a valuable aid in choosing exactly which cells will be analyzed further on. PRINCIPLE OF THE METHOD: Laser microdissection is based on using the energy of a focused laser beam to cut through the thickness of the tissue that is placed on a microscope slide in order to obtain cell samples previously selected by the pathologist through special software. CONCLUSIONS: To be able to cut the cells that you want and analyze them further without having them contaminated with other cells means that you can get more insight into the progression of the mutations that occur in these malignant cells, mutations that cause them to become more aggressive or multidrug-resistant. This could in time lead to the discovery of new molecular targets for cancer therapy.

The role of DNA repair by homologous recombination in oncogenesis.

DNA repair by homologous recombination (HR) may be regarded as the two faces of a coin: lowering the oncogenetic potential (precise repair with no consequences on genomic status) or increasing it (deleterious action which may determine chromosome rearrangements such as loss of heterozigosity). Inherited mutations in genes involved in HR are associated with gene rearrangement and may be a prerequisite for tumor development in some cancer-prone hereditary diseases like Bloom, Werner and Rothmund-Thomson syndromes. Normal eukaryotic cells show some degree of balance between various mechanisms of repair. This review presents the main mechanisms and pathways of homologous recombination repair (synthesis-dependent single strand annealing, constitution of Hollidayjunctions with their resolution mechanisms and repair by break induced replication), the proteins involved in it and their contribution to oncogenesis.

Predictive value of cellular immune response in cervical cancer.

UNLABELLED: Despite recent advances in the immune mechanisms of cervical cancer (CC), the relapse still remains an actual issue and recognition of new predictive biomarkers is essential. AIM: The purpose of this retrospective study was to investigate possible differences in the primary, in situ, cellular immune response between cervical carcinoma with and without relapse. MATERIAL AND METHODS: Paraffin-embedded tissue samples from 61 consecutive women with CC (34 with and 27 without relapse) were immunostained for CD3, CD20 and CD45 cells. Immune cell profile densities were further assessed, assigning scores between 0 and 3: "0" meaning the absence of inflammatory infiltrate, "1+" low, "2+" intense and "3+" intense infiltrate with lymphoid follicles. Statistical analysis was performed in SPSS-13 software, p<0.05. RESULTS: Statistically significant intra- and peri-tumoral low numbers of several immune cell subtypes are strongly associated with relapse of disease within three and five years in patients with CC (p<0.05); moreover, statistical significant correlations between immune cells and both free survival (CD3: r=0.382; CD20: r=0.404; CD45: r=0.376) and relapse (CD3: r=-0.408; CD20: r=-0.355; CD45: r=-0.354) have been demonstrated. Only CD3 was reported as predictive biomarker of relapse in CC (ANOVA, t-Student, p<0.05). CONCLUSIONS: Major differences in the cellular immune response among patients with cervical cancer with and without relapse within three and five years have been demonstrated. CD3 may be used as potential prognostic biomarkers, whereas the results are promising for adjuvant immunotherapy.

[Vascular molecular markers for determination of disease free survival (DFS) of breast cancer]. / Markeri moleculari vasculari în determinismul intervalului liber de boala a cancerului mamar.

The heterogeneity of the evolution of breast cancer complicates patient management. The use of vascular markers as prognostic factors is a new and promising tool in medical oncology. Research data of the current decade demonstrate that angiogenesis plays substantial role in growth and spread of malignant tumor. At present, immunohistochemical determination of intratumoral microvascular density represents one of the more promising new prognostic indicators in breast cancer that needs to be further investigated to identify and standardize the method of choice to be tested in prospective clinical studies. Consequently markers of angiogenic activity have receiving increasing attention. By analyzing the evolution of 209 cases of breast cancer enrolled in a prospective study reaching the 5th year of follow up, we provide herein data supporting that Factor VIII and CD34 could be reliable markers for prognosis of DFS. Tumors with lower expression of Factor VIII and CD34 have a better prognostic and lower potential metastatic. The Factor VIII comparative with CD34 represents a more faithful prognostic marker. Angiogenesis markers have also become a putative therapeutic target.

Use of the presence of anti-protein gag antibodies as an evolution marker of HIV infection.

The paper studies the modifications occurring in the prevalence of anti-protein gag antibodies during the evolution of the infection in a paediatric population iatrogenically infected and not submitted to antiretroviral treatment. The study was performed by annual clinical examination of children and by laboratory determinations: western-blot, p24 Ag assay, determination of lymphocyte population by flowcytometry. The predictive capacity of p17 antibodies was revealed, their occurrence after seroconversion pointing to a favourable evolution, with a longer asymptomatic period; the disappearance of these antibodies during the disease indicates a more advanced stage of the disease. The disappearance of p24 and p55 antibodies during the evolution of the disease shows a more advanced stage of the disease, both clinically and as concerning the immunosuppression degree.