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Sammichele di Bari, Italy

Telcian A.G.,Imperial College London | Laza-Stanca V.,Imperial College London | Laza-Stanca V.,Royal Infirmary | Edwards M.R.,Imperial College London | And 13 more authors.
Journal of Infectious Diseases

Respiratory syncytial virus (RSV) is a major cause of bronchiolitis in infants. It is also responsible for high morbidity and mortality in the elderly. Programmed death ligands (PD-Ls) on antigen-presenting cells interact with receptors on T cells to regulate immune responses. The programmed death receptor-ligand 1/programmed death receptor 1 (PD-L1-PD-1) pathway is inhibitory in chronic viral infections, but its role in acute viral infections is unclear. We hypothesized that bronchial epithelial cell (BEC) expression of PD-Ls would inhibit local effector CD8+ T cell function. We report that RSV infection of primary human BECs strongly induces PD-L1 expression. In a co-culture system of BECs with purified CD8+ T cells, we demonstrated that RSV-infected BECs increased CD8+ T cell activation, proliferation, and antiviral function. Blocking PD-L1 on RSV-infected BECs cocultured with CD8+ T cells enhanced CD8+ T cell IFN-γ, IL-2, and granzyme B production. It also decreased the virus load of the BECs. Based on our findings, we believe therapeutic strategies that target the PD-L1-PD-1 pathway might increase antiviral immune responses to RSV and other acute virus infections. © The Author 2011. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. Source

Bratucu E.,University of Bucharest | Stanescu A.,University of Bucharest | Straja D.N.,University of Bucharest | Cirimbei C.,University of Bucharest | And 6 more authors.
Chirurgia (Romania)

The congenital anomalies of the common bile duct (CBD) represent a real challenge for the surgeon, and not recognizing them may have two consequences: either generate incomplete or incorrect surgical solutions, or, even worse, lead to iatrogenic pathology. The association between the anomalies of the CBD and biliary lithiasis, biliary cancer or other hepatobiliopancreatic pathology may lead to a pre/perioperative diagnosis; frequently, the incertitude persists. We present 2 cases: one with an incomplete duplication of the CBD and the other with a false duplication. We wish to underline the sovereign value of cholangio-MRI with 3 D reconstructions in the diagnosis and description of the anatomy of the biliary ducts, superior, in some cases, to the intraoperative cholangiography or ERCP. Copyright © Celsius. Source

Voinea S.,Carol Davila University of Medicine and Pharmacy | Sandru A.,Bucharest Oncologic Institute | Sandru A.,Carol Davila University of Medicine and Pharmacy | Gherghe M.,Oncologic Institute | Blidaru A.,Carol Davila University of Medicine and Pharmacy
Chirurgia (Romania)

In the recent years, the identification and biopsy of the sentinel lymph node (SLN) has become standard in the treatment of cutaneous malignant melanoma (CMM). In order to correctly apply the technique and to decrease the risk of false negatives, it is compulsory to track the lymphatic drainage of the primary tumor and to detect all SLN, regardless of their site. Method: At the Bucharest Oncologic Institute, over the last three years, selective lymphadenectomy was performed in 75 patients with CMM, stages I and II (AJCC). In 39 cases, the primary tumor was at the level of the upper and lower limbs and in 36 on the trunk. In all patients, lymphoscintigraphy was performed through intradermal injection of Nanocoll, with dynamic follow up of the radiotracer, with the purpose of finding the possible unusual locations of the SLN. Results: The sentinel lymph nodes were identified in 100% of the cases. In 63 patients (84%), the primary tumor drained in only one lymphatic field and in the other 12 the drainage was towards 2 or more lymphatic basins. The CMM situated on the trunk had a particular behaviour, presenting more often (33%) with multiple nodal basin drainage. Conclusions: CMM of the trunk, mostly those situated close to the midline, but others as well, tend to drain into several lymphatic areas. The existence of interval lymph nodes and atypical lymphatic drainage, in a minor lymphatic basin, must be determined preoperatively in order to allow the biopsy of all SLN and establish the right therapy. © Celsius. Source

Alon S.,Oncologic Institute
Asian Pacific Journal of Cancer Prevention

The purpose of the paper is to discuss means of assisting terminally ill patients in seeking for sources of meaning and hope, alongside the acknowledgment that their lifespan is short.Psycho-spiritual aspects make a substantial component patients suffering from incurable illness have to deal with. Evaluating and mapping the causes and expressions of psychological - spiritual suffering may assist in tailoring appropriate strategies of distress relief. Therefore, interventions should be given in accordance with their specific focus of difficulties, as well as with wishes and needs. Appropriate interventions in palliative psychotherapeutic rapport are inspired by identifying new sources for meaning in current life (sometimes, aided by past experiences or future visions). Reinforcing sources for meaning may attempt in providing patients amongst: - Equilibrium, between suffering and sorrow (which sometimes take over the patient's world), and on the other hand, new experiences, sense of satisfaction and fulfillment. Individual's acknowledgment that he is not completely withdrawn from the circle of life, and yet significance and fulfillment in life still exists. For a holistic meaning - centered intervention it is advisable to simultaneously integrate two central axes: the existential analysis, inspired by concepts driven from Frenkl's Logotherapy, such as freedom of choice, personal responsibility, inner truth, hope and transcendentalism; the operative axis, enhancing meaning and hope by assisting patient's wishes come true. Patients are aware, many times, that those wishes may be their last one, therefore perceive their fulfillment as crucial for their sense of meaning. Moreover, those wishes may elevate patient and family's spirit and reduce risk of demoralization. Whereas existential - spiritual interventions are recommended to be given by qualified professional therapists, the operation of fulfilling wishes is feasible by everyone, from family members to multidisciplinary staff. Case illustrations for meaning - centered interventions will be discussed in the course of the paper. Cultural and traditional differences within the Israeli society, expressed in themes of work with patients, will lead to the conclusion, that there are many creative ways for researching meaning of life and sources for hope. Source

Aldea M.,Oncologic Institute | Ciulcu A.,Dr. I.Cantacuzino Hospital | Albu S.E.,Clinic of Obstetrics Gynecology | Horhoianu I.,Clinic of Obstetrics Gynecology | Vartej P.,Clinic of Obstetrics Gynecology
Archives of the Balkan Medical Union

The aim of this paper lies in the demonstration of the embolization efficacy in the vaginal hemorrhages management: obstetrical and gynecological (with a neoplasic substrate). Material and method: In this respect, there have been prospectively analysed 9 cases with vaginal bleeding (cervicorrhages) occured within the advanced stadial evolution of the uterine cervix carcinoma- during the period 2009-2010 ; we shall present out of these cases the particular case of a pregnant woman (VI P-gestational age of 16 weeks) with cervical carcinoma stage IB2; the patient aged 41 years old presented for the pregnancy evacuation in order to initiate the oncologic therapeutic protocol. There are further on presented the technic details concerning the embolization. Results- discussion: There are presented 3 cases- with the corresponding imaging- (out of the 9 analysed)- with vaginal bleedings (within the advanced stadial evolution of the cervical carcinoma)-and the prompt efficacy of the embolization in the hemostatic way. There are mentioned the possibilities of the catheter technique use (concerning the embolization) in the prophylactic and curative ways (intraarterial administration of the cytostatic). Conclusion: The embolization represents a safe and efficient miniinvasive technique. Copyright © 2011 CELSIUS. Source

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