The prognostic significance of the clinical and histological parameters in primary cutaneous melanoma patients.

Cutaneous melanoma is the most aggressive form of skin cancer and its incidence is unfortunately increasing. In the last decades, a progressive increase of new cases of diagnosed thin melanoma has been noted. This may be due to earlier detection, better surveillance, improved diagnostic criteria or increased exposure to sunlight. Despite the fact that Breslow tumor thickness has the strongest proven prognostic significance, there are still thin melanomas that metastasize and thick melanomas with favorable evolution. Therefore, the identification of strong predictive factors for survival is mandatory, particularly for patients with thin melanoma.

Current Challenges in Deciphering Sutton Nevi-Literature Review and Personal Experience.

Halo nevi, known as leukoderma acquisitum centrifugum, Sutton nevus, leukopigmentary nevus, perinevoid vitiligo, or perinevoid leukoderma, together with vitiligo and melanoma-associated hypopigmentation, belong to the group of dermatoses designated as immunological leukodermas. The etiology and pathogenesis of halo nevi has not been fully elucidated. There are several mechanisms through which a lymphocytic infiltrate can induce tumoral regression. In this review, we aimed to update the knowledge about Sutton nevi starting with the clinical appearance and dermoscopic features, continuing with information regarding conventional microscopy, immunohistochemistry, and the immunological mechanisms responsible for the occurrence of halo nevi. We also included in the article original unpublished results when discussing dermoscopic, pathologic and immunohistochemical results in halo nevi. Sutton nevi are valuable models for studying antitumor reactions that the human body can generate. The slow and effective mechanism against a melanocytic skin tumor can teach us important lessons about both autoimmune diseases and anticancer defenses.

Aging and Vascular Compliance in Hypertensive Patients Mirrored in Routine Investigations.

The global prevalence of arterial hypertension is increasing. Due to its consequences, hypertension is a leading cause of morbidity /mortality. In this regard, awareness of the importance of diagnosis as well as proper treatment of hypertension is mandatory. OBJECTIVES: This study aims to analyze vascular compliance and different pressure characteristics depending on age, along with highlighting some clinical-paraclinical correlations in people diagnosed with hypertension. We used usual laboratory analyzes and the blood pressure values obtained using ABPM/24 hr, in addition to highlighting the impact of age on those parameters. MATERIALS AND METHODS: The sample comprises of 99 adults diagnosed with hypertension. We divided them into 2 groups, according to age: cases sample: 52 patients (age> 60 years old) and control sample: 47 patients (age< 60 years old). RESULTS: In the control group, RDW was correlated with the general and diurnal systolic and diastolic hypertonicity indexes and the platelet count was positively correlated only with the morning surge. The dipping profile correlates negatively with RDW. In the elderly, all three systolic blood pressure parameters are influenced by ESR and also correlate negatively with HDL, with an inverse proportional relationship. Statistically significant correlations were found between blood glucose and diurnal systolic and diastolic hypertonicity indexes. Mean Pulse Pressure correlates in the elderly with HDL (negative correlations) and in the young with RDW (positive correlations). CONCLUSIONS: Vascular compliance can be estimated with the help of HDL in the elderly and RDW in young people, considering the influence of the two parameters on pulse pressure.

Inflammation and Arterial Hypertension-Pathophysiological Links and Clinical Aspects.

Arterial hypertension represents one of the most common pathologies in the adult population. Hypertensive patients have structurally altered arteries, with a higher rigidity that leads to a significant decrease in vascular compliance. At the base of the pathophysiological process stands the inflammation, as a reaction of the organism to injury. OBJECTIVES: This study aims to highlight clinical-paraclinical correlations in people diagnosed with arterial hypertension and inflammatory status. Thus, we would like to evaluate possible correlations between the usual inflammatory markers and blood pressure values. MATERIALS AND METHODS: The sample comprises 64 adults who were subsequently divided based on the diagnosis of arterial hypertension, by using Automatic Blood Pressure Monitoring, as following: Study group=26 patients (with arterial hypertension) and Control group: 38 patients (without arterial hypertension). RESULTS: The study has revealed negative correlations between the neutrophil/lymphocyte ratio (NLR) and the general diastolic average (r=-0.248 and p=0.047), the diurnal diastolic average (r=-0.258 and p=0.038) and the diurnal mean arterial pressure (r=-0.249 and p=0.046) and a negative correlation between the red cell distribution width (RDW) and the dipping index (r=-0.402 and p=0.013), each of them accomplishing the level of statistical significance. CONCLUSIONS: NLR can be used as a predictor of diastolic blood pressure values and as a factor of prognosis for the evolution of arterial hypertension. RDW is higher in non-dipping patients.

Immunohistochemical Aspects of Cell Death in Diabetic Nephropathy.

INTRODUCTION: Diabetes Mellitus causes ultrastructural changes triggered by partially clarified cellular mechanisms. Since cell death is an important mechanism in the appearance and progression of diabetic nephropathy, we studied alteration of several markers of apoptotic pathways signaling in renal tissue of diabetic or prediabetic patients. METHODS: We analyzed 48 human kidney tissue samples divided into two study groups: the research group (43 renal tissue samples from diabetic or prediabetic patients), and the control group (5 renal tissue samples from patients without diabetes). Immunohistochemistry revealed expression of Bcl-2, APAF-1, CD-95 and Caspase-9 in the renal cortical structures. Statistical analysis was also performed (significance level P < 0.05). RESULTS: We found a variable expression of the antiapoptotic Bcl-2 with a decrease of Bcl-2 expression in diabetes. The control samples render evident intensely positive immunostaining for CD-95. In diabetes and diabetic nephropathy, there was positive immunostaining for APAF-1 at tubular cell level. Nuclear and cytoplasmic positivity for Caspase-9 was more frequently recorded as kidney damage progresses. APAF-1 and Caspase-9 positivity are arguments for an intrinsic apoptotic mechanism of cell death in diabetic nephropathy. CONCLUSION: The mechanisms of apoptotic cell death identified in diabetic kidney samples prove that Bcl-2, CD-95, APAF-1 and Caspase-9 represent reliable markers of cell death in human renal tissue. Our results support the hypothesis that apoptosis is a pathogenic and initiator mechanism of renal remodeling in diabetic kidney disease.

Caspases, Cell Death and Diabetic Nephropathy.

Diabetic Nephropathy. In 2014 (according to data published by the World Health Organization) 9% of the global population was affected by Diabetes which was considered to be directly responsible for 1.5 million deaths just two years prior (in 2012). From the entire number of patients suffering from diabetes, approximately a quarter of them develop renal affection. Diabetic nephropathy has similar physiopathology mechanisms and ultrastructural changes in cell injury characteristics in both Type 1 and Type 2 diabetes. Cell Death. Cell Death was less studied in the renal diabetic disease, although it could represent an important pathogenic mechanism in the appearance and progression of nephropathy. At renal level the cellular loss can be explained by several mechanisms; different stimuli with cellular lesion potential can trigger apoptosis signaling with appearance of regulatory proteins having a double role (they participate in the initiation of the apoptosis path and cell death or in the ending of this process). The types of Cell Death and their relative proportion between themselves in the renal tissue have not been completely elucidated. Caspases. Discovered in the middle of the 1990's, Caspases are a part of the cysteine proteases family and play a role in numerous aspects of physiology (having a role in development, aging and apoptosis), but also in aspects of physiopathology of several degenerative affections, autoimmune diseases, oncologic diseases - having an important part in apoptosis, necrosis and also inflammation.

Early onset of podocytes apoptosis - a TEM study in streptozotocin-induced diabetic rats.

Cell death types are usually defined by morphological criteria. Even though podocyte loss is associated with various cell death mechanisms, podocyte apoptosis is rarely detected. The purpose of this study is to evaluate whether morphological signs of apoptotic cell death could be detected in early streptozotocin-induced diabetes in rats kidneys. There were used five Wistar rats, and renal tissue samples were drawn after three weeks of disease and further evaluated in transmission electron microscopy (TEM). Podocytes damage was indicated by two major findings: foot processes effacement, viewed as loss of cell processes, and chromatin condensation and margination (partial karyopyknosis: peculiar nuclear morphologies - partly normal, euchromatic, and partly positive for karyopyknosis and nuclear shrinkage). Mitotic glomerular endotheliocytes were also encountered. Podocytes cell death commitment and detachment appeared as concomitant events. However, karyopyknosis is not a specific feature of apoptosis. Thus, further biochemical evaluations are needed to distinguish between different pathways of podocytes death.

Traditional and nontraditional risk factors for atherosclerosis in patients with systemic lupus erythematosus.

Premature atherosclerosis (ATS) in SLE patients is an important clinical problem. It is explained not only by excess of traditional risk factors, but also by specific factors linked to disease activity and therapy. Such specific factors include the following: antioxLDL and anti CRP antibodies, immune complexes, mannose-binding lectin, disturbances of metabolism of annexin A5, antiphospholipid syndrome, immunologically determined dyslipidemia, influence of medication. As a conclusion,atherosclerosis in SLE patients results from an interplay between traditional and nontraditional risk factors. Therapeutic influences suggest antiatherogenic effects for hydroxychloroquine and immunosuppressants and a doubtful proatherogenic influence of cortisone.