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Insulinooporność oznacza upośledzoną wrażliwość tkanek na insulinę, najczęściej związaną z defektem insulinowego szlaku przekaźnictwa wewnątrzkomórkowego sygnału. Insulinooporność hepatocytów manifestuje się przede wszystkim niekontrolowaną produkcją i uwalnianiem glukozy z wątroby, czego skutkiem jest hiperglikemia. Prowadzi do zaburzeń metabolicznych, zwłaszcza dotyczących gospodarki węglowodanowej, jak również lipidowej prowadząc do nadmiernej akumulacji lipidów w wątrobie. Wewnątrzkomórkowy nadmiar lipidów estryfikowany jest przede wszystkim do triacylogliceroli (TAG), diacylogliceroli (DAG) i ceramidów (CER), które w sposób bezpośredni interferują z insulinowym szlakiem przekaźnictwa sygnału, nasilając insulinooporność hepatocytów. Wzrost zawartości diacylogliceroli wewnątrz hepatocytów powoduje wzmożenie aktywności kinazy białkowej C (PKC), a nadmierna akumulacja ceramidów może być przyczyną inaktywacji kinazy białkowej B (PKB), czego skutkiem jest fosforylacja i dezaktywacja substratu receptora insulinowego (IRS-1), co prowadzi do zmniejszenia translokacji transporterów dla glukozy do błony komórkowej (GLUT-2). Znaczenie insulinooporności hepatocytów przede wszystkim objawaia się rozwojem zespolu metabolicznego, wzrostem ryzyka sercowo-naczyniowego i przewpleklym prozesem zapalanym i nowotworzeniem.
Multiple myeloma is a neoplastic disease which is characterised by proliferation of monoclonal plasmocytes in the bone marrow. It is the second most common hematologic cancer and it represents 1% of all cancer deaths. Despite enormous development in multiple myeloma biology and treatment over the last 30 years - it is still incurable disease with a median survival of 50 – 55 months. Currently, one of the most important goals in the treatment of multiple myeloma is to achieve long-term control of the disease, without negative impact on the patient’s quality of life. Thanks to therapeutic regimens based on new immunomodulatory drugs, this aim seems to be achievable. In this paper we present the case of a female patient living with multiple myeloma for 14 years. Initially patient was treated with standard VAD (vincristine, doxorubicin, dexamethasone) chemotherapy regimen. After a nearly complete remission of the disease, autotransplantation of hematopoietic cells was performed. One year after transplantation there was a relapse of the disease. In the treatment of relapse it was decided to use scheme based on lenalidomide and dexamethasone. After 4th cycle of treatment, a complete remission was achieved. So far, the patient received 149 cycles. In the evaluation of minimal residual disease still maintains a state of complete remission maintains. During over 12 years of treatment no complications in grade 3 and 4 of the CTCAE v.4 was observed. Currently the patient is 58 years old, she still receives lenalidomide and leads moderately active life.
Introduction: Despite the progress which has been made in the diagnosis and treatment of lung cancer, it is still one of the main causes of death in both men and women. The introduction of new therapeutic modalities did not improve the 5-year survival results of lung cancer patients. The Lublin Voivodeship is a sparsely-inhabited area with little urbanization and a population of about 2.2 million people. Only 46.8% of its citizens live in the towns, while the national average is 61.9%. Objectives: The aim of the study was to compare the differences in the periods of time and reasons for delay in diagnosis and initiation of treatment of lung cancer among patients who are inhabitants of the rural and urban regions of Lublin Voivodeship, and who were consulted in Thoracic Surgery Department. Materials and methods: 300 lung cancer patients who were consulted in the Thoracic Surgery Outpatient Clinic or who were hospitalized in the Department of Thoracic Surgery in the period between 2 January 2010 – 7 January 2011 were included in the study. Delays were calculated for two periods of time: 1) time from the first signs of the disease to the first medical examination; 2) the time from the first visit to a doctor to the start of treatment, or disqualification from the causative treatment. The time of the first delay for the urban and rural populations was similar and ranged from 2-37 weeks and 2-23 weeks, respectively. Lack of time and disregard of signs of disease were the most commonly reasons given for the first delay among rural residents. The urban population indicated fear and lack of time as the main reasons of delay. Assessment of the second reason for delay was possible thanks to a specially designed research protocol which gathered the main reasons of delay in several subgroups that enabled their statistical evaluation. The length of second period was similar for both populations. Results: There were no significant differences in the length of the time of delay between the two assessed groups. In both groups, delays dependent on poor healthcare access were similar. Among rural inhabitants, the most often reasons of delay were waiting for hospital admission and re-bronchoscopy. In the urban population, the most common reasons for delay were waiting for hospitalization and CT procedure. Conclusions: The results of the presented research allowed the following conclusions to be drawn: between the two assessed groups there were no differences in the length of the time of delay; 2) delays in diagnosis and treatment were too long for the patients and could affect the severity of the disease and final prognosis; 3) there is a need for intensification of information campaigns on lung cancer in order to reduce the delays dependent on patients, and to improve the cooperation of family doctors, pulmonologists, thoracic surgeons and oncologists.
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