In recent decades, significant progress has been made in understanding the mechanisms of platelet function and platelet hemostasis correction. Platelets are considered as the most important participants of both normal, and pathological thrombotic process characteristic of the most different diseases and states. In the present review pathophysiological mechanisms of platelet synthesis of various mediators with paracrine effects, which can influence the function of other cells, are consecrated. The physiology of platelets was considered in detail. The leading role of platelets in pathogenesis of the majority of diseases of cardiovascular system as modulators of inflammatory reactions of the immune response which are considered as the leading mechanism of development of atherosclerosis was shown. The ability of platelets to encode inflammatory proteins allowing them to influence adaptive immunity functions was discussed. The role of platelets as a key component of the innate immune system was presented, which is confirmed by the presence of Tolllike receptors (TLR) and glycoproteins, such as integrin αIIbβ3, glycoprotein Ib-IX and FcγRIIa, involved in interaction with bacterial cells. The pathogenesis of the formation of platelet-leukocyte aggregates due to the rapid reversible interaction of P-selectin (CD62P) on the platelet surface with ligand-1 glycoprotein P-selectin (PSGL-1) on the plasma of leukocytes and the mechanism of extracellular neutrophil traps (NETs), as well as the influence of platelets on the function of lymphocytes was presented. The role of platelets in cancer progression, metastasis and thrombosis is considered, and the interrelation of thrombosis and metastasis in malignant diseases was analyzed. The efficiency of the use of antithrombotic drugs in the prevention of thrombosis and, as a consequence, in the prevention of cardiovascular diseases and cancer was discussed.
In order to identify the features of violations of free-radical processes in blood serum of 94 untreated cancer patients with different localization of the tumor (cancer of the stomach, colon, breast, ovarian, hemoblastoses) were determined selenium levels and indicators of oxidative stress (sum of metabolites of nitrogen - NOx, the level of superoxide dismutase - Cu/ZnSOD and malondiialdehyde-MDA, and the activity of catalase). In addition, 40 patients with malignant liver disease and clinical signs of liver failure in the early postoperative period was carried out a comparative evaluation of the efficacy of selenium-containing drug 'Selenaze' (sodium selenite pentahydrate). It was found that selenium levels in cancer patients by 25-30% below the norm of 110-120 mg/l at a rate of 73.0±2.6 mg/l. Low levels of NOx was detected in patients with all tumor localizations (22.1±1.1 mM, with normal range 28.4±0.9 mM). The exceptions were patients with extensive malignant process in the liver, in which the NOx levels were significantly higher than normal (p<0.001). The high level of NOx has a toxic effect on the hepatocyte, causing metabolic disorders and inflammatory-necrotic changes in the liver. Elevated levels of SOD and MDA in normal values of catalase activity was detected in all patients. The use of 'Selenaze' in postoperative patients with tumors of the liver increased selenium levels by 10-12%, which was accompanied by a decrease in the content of SOD and NOx, and contributed to earlier recovery of detoxic and synthetic liver function. These findings point to an intensification of oxidative stress and metabolic disorders in the malignant process, which is the basis for metabolic correction.
Инфицирование Pseudomonas aeruginosa (P. aeru gino sa) является чрезвычайно опасной причиной сепсиса у больных с нейтропенией, вызванной противоопухолевой терапией. P. aeruginosa, неферментирующая грам-отрица тельная бактерия, широко распространена в природе: в почве, открытых водоемах, на растениях (в том числе сельскохозяйственных), а также любых влажных местах в помещениях: стоках канализации, кранах и сливах раковин, длительно переживая и размножаясь даже в условиях, крайне неблагоприятных для многих других микроорганизмов. В связи с этим и высокой болезнетворностью P. aeruginosa является важной причиной внутрибольничной инфекции, особенно у пациентов с нарушениями иммунной системы и барьерной функции кожи и слизистых [1]. Инфекция кожи, вызванная P. aeruginosa, может проявляться в виде разнообразных элементов сыпи (папул, макул, петехий или пурпуры, везикул, пустул, геморрагических булл), целлюлита
Aim of the study: To determine clinical course of Burkholderia cenocepacia bacteremia and outcomes in patients receiving cancer therapy. Materials and methods: We indentified 10 adult patients with culture-verified catheter-related Burkholderia cenocepacia bacteremia. Pathogens were identified with protein mass spectrometry of bacteria cells. Testing for the «Microscan WalkAway 40/96 Plus» (Germany) did antibiotic sensitivity or «VITEK 2» (France). Results: In the majority of cases course of bacteremia was indolent; this fact precluded its rapid identification with standard procedures for diagnosing bloodstream infection. All patients developed fever but we revealed neither leukocytosis nor leucopenia which could be attributed to active infection. However, antibiotic treatment was initiated during the 24 h after the first signs of infection in all cases. In one patient bacteremia was complicated with septic shock. We revealed that Burkholderia cenocepacia was able to form biofilms and persist in implanted venous port systems after treatment and in order to eradicate the pathogen venous catheters had to be removed despite effective antibacterial treatment. Initial treatment was prescribed empirically and further antibacterial treatment was adjusted based on sensitivity testing results in 7 patients. Burkholderia cenocepacia eradication rate was 100% and all patients were cured and were able to continue prescribed cancer therapy afterwards. Conclusion: given to the low frequency of Burkholderia cenocepacia sporadic infections, clinicians must be aware of the possibility of drugs and medical supplies contamination with this pathogen. If one reveals ≥1 case of Burkholderia cenocepacia-associated infection the internal investigation must be initiated. Empiric antimicrobial therapy widely prescribed to treat febrile neutropenia in cancer patients is effective in these cases. However, it cannot eradicate the pathogen from inner lumen of implanted venous catheters. Identification of the possible pathogen in blood cultures and antibiotics sensitivity testing using microbiological analyzers prompts the diagnosis of bacteremia and prescription of most effective therapy
Background. There is a wide spectrum of metabolic and toxic disorders that can cause acute encephalopathy in cancer patients. In routine clinical practice, hypoglycemia, vitamin B1 (thiamine) deficit, fulminant liver failure, uremia, severe hypoand hypernatremia should be primarily excluded. Central neurotoxicity associated with hyperammonemia in patients receiving 5-fluorouracil (5-FU) and oral fluoropyrimidines should be considered in differential diagnosis. In this case, the analysis of the blood acid-base status and the detection of B-type hyperlactatemia can facilitate the diagnosis of the cause of encephalopathy.Case description. We present two cases of hyperlactatemia and encephalopathy in stage IV cancer patients with continuous infusion of 5-FU via a portable infusion pump.Conclusion. Diagnosis of the frequent fluoropyrimidin-related adverse effects, such as myelosuppression, anorexia, diarrhea, mucositis, and palm-plantar syndrome, are routine and mastered by an oncologist at the very beginning of his/her professional activity. Specific fluoropyrimidinerelated encephalopathy or hyperlactatemia are difficult to suspect and recognize. We hope our description will be useful to prevent possible diagnostic errors.
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