Katarzyna Gniadek-Olejniczak

Wprowadzenie i cel: Cerebrolizyna jest preparatem o wielomodalnym działaniu cerebroprotekcyjnym, mogącym wpływać na działanie bariery krew–mózg, jednostki nerwowo-naczyniowej, oraz procesy plastyczności po uszkodzeniu ośrodkowego układu nerwowego. Celem pracy jest syntetyczna prezentacja i krytyczna ocena nowych danych klinicznych (opublikowanych po 2020 roku) dotyczących zastosowania cerebrolizyny w ostrej fazie udaru niedokrwiennego, w tym jako terapii skojarzonej z reperfuzją, oraz w neurointensywnej opiece u pacjentów z pourazowym uszkodzeniem mózgu. Materiał i metody: Przeprowadzono przegląd narracyjny randomizowanych badań klinicznych, metaanaliz oraz badań prospektywnych i obserwacyjnych, uwzględniając analizę NIHSS (National Institutes of Health Stroke Scale), zmodyfikowaną skalę Rankina (mRS), transformację krwotoczną (HT), w tym objawową (sHT), a także bezpieczeństwo i wykonalność leczenia. Wyniki: Badania nad terapią łączoną cerebrolizyną z dożylną trombolizą z użyciem tkankowego aktywatora plazminogenu (CEREHETIS, CERE-LYSE) wykazały redukcję sHT po trombolizie i szybszą poprawę ocenianą w skali NIHSS, przy braku różnic w 90-dniowym mRS. W rejestrze C-REGS2 u chorych z umiarkowaną ostrą fazą udaru niedokrwiennego cerebrolizyna wiązała się z korzystnym przesunięciem rozkładu mRS i lepszymi wynikami funkcji poznawczych. Trzy badania obserwacyjne po trombektomii, w tym jedno z 12-miesięczną obserwacją (CEREBROLYSIN-WIM Study) sugerują większą szansę uzyskania niezależności funkcjonalnej i redukcję HT/sHT, jednak brak randomizacji ogranicza możliwość wyciągania wniosków przyczynowych. W pourazowym uszkodzeniu mózgu projekt CAPTAIN (185 chorych) wykazał korzystny wpływ na globalny wielowymiarowy punkt końcowy oceniany w 90. dobie, przy porównywalnym bezpieczeństwie. Metaanalizy wskazują na poprawę wyników w skali Glasgow, bez redukcji śmiertelności, przy istotnej heterogenności danych. Wnioski: Istnieją obiecujące przesłanki dotyczące roli cerebrolizyny jako terapii wspomagającej reperfuzję/rehabilitację w ostrej fazie udaru niedokrwiennego oraz jako interwencji wspomagającej w pourazowym uszkodzeniu mózgu. Potrzebne są jednak wieloośrodkowe randomizowane badania kliniczne z precyzyjną selekcją pacjentów oraz optymalizacją czasu, dawki i długości leczenia.

Background: Cardiotoxicity remains a concern across cancer therapies. To date, there is a lack of extensive studies evaluating the potential impact of radioligand therapy (RLT) on myocardial injury in patients with neuroendocrine tumors (NETs), particularly in subgroups with increased susceptibility to such injury. This study aimed to assess the potential cardiotoxic effects and myocardial dysfunction associated with RLT using both [¹⁷⁷Lu]Lu-DOTA-TATE and tandem therapy with [¹⁷⁷Lu]Lu-DOTA-TATE/[⁹⁰Y]Y-DOTA-TATE in patients with NETs, including specific high-risk subgroups such as patients with pre-existing heart failure, carcinoid heart disease or those previously treated with chemotherapy, by monitoring serum concentration of troponin I, CK-MB, and NT-proBNP before and after RLT. Methods: We conducted a retrospective observational analysis of 60 consecutive NET patients who underwent 228 RLT courses. A comprehensive cardiac assessment, including a detailed medical history, was performed. Additionally, serum troponin I, CKMB and NT-proBNP concentrations were measured prior to treatment and 48 h post-therapy. Fifty-two patients received [¹⁷⁷Lu]Lu-DOTA-TATE monotherapy, while eight patients were treated with tandem therapy. Results: No increase in cardiotoxicity markers was observed in the overall study population following RLT administration (ΔTroponin −0.2 [−1.4–0.3]ng/L, p = 0.007; ∆CKMB 0.0 [−4.0–3.0]U/L, p = 0.90; ΔNT-proBNP 4.0 [−45.6–33.6]pg/mL) as well as in the subgroup receiving tandem therapy (ΔTroponin 0.7 [−1.7–013]ng/L, p = 0.68; ΔCKMB −0.5 [−10.7–3.0]U/L, p = 0.21; ΔNT-proBNP −21.6 [−44.1–16.7]pg/mL). Furthermore, none of the predefined patient subgroups exhibited signs of cardiotoxicity or evidence of myocardial dysfunction. Conclusions: RLT is a safe anticancer treatment option for patients with NETs in terms of cardiotoxicity and cardiac dysfunction, including those at higher risk of cardiovascular complications.

Background: Cardiotoxicity remains a concern across cancer therapies. To date, there is a lack of extensive studies evaluating the potential impact of radioligand therapy (RLT) on myocardial injury in patients with neuroendocrine tumors (NETs), particularly in subgroups with increased susceptibility to such injury. This study aimed to assess the potential cardiotoxic effects and myocardial dysfunction associated with RLT using both [¹⁷⁷Lu]Lu-DOTA-TATE and tandem therapy with [¹⁷⁷Lu]Lu-DOTA-TATE/[⁹⁰Y]Y-DOTA-TATE in patients with NETs, including specific high-risk subgroups such as patients with pre-existing heart failure, carcinoid heart disease or those previously treated with chemotherapy, by monitoring serum concentration of troponin I, CK-MB, and NT-proBNP before and after RLT. Methods: We retrospectively analyzed 60 consecutive NET patients who underwent 228 RLT courses. A comprehensive cardiac assessment, including detailed medical history, was performed. Additionally, serum troponin I, CKMB and NT-proBNP concentrations were measured prior to treatment and 48 hours post-therapy. 52 patients received [¹⁷⁷Lu]Lu-DOTA-TATE monotherapy, while 8 patients were treated with tandem therapy. Results: No increase in cardiotoxicity markers was observed in the overall study population following RLT administration ( D Troponin -0.2[-1.4-0.3]ng/L, p=0,007; D CKMB 0.0[-4.0-3.0]U/l, p=0,90; D NT-proBNP 4.0[-45.6-33.6]pg/mL) as well as in the subgroup receiving tandem therapy ( D Troponin 0.7[-1.7-013]ng/L, p=0,68; D CKMB -0,5[-10.7-3.0]U/l, p=0,21; D NT-proBNP -21.6[-44.1-16.7]pg/mL). Furthermore, none of the predefined patient subgroups exhibited signs of cardiotoxicity or evidence of myocardial dysfunction. Conclusions: RLT is a safe anticancer treatment option for patients with NETs in terms of cardiotoxicity and cardiac dysfunction, including those at higher risk of cardiovascular complications.

Background: Renal cell carcinoma is one of the most aggressive urogenital malignancies, with an increasing number of cases worldwide. The majority of cases are diagnosed at an advanced stage, as this form of growth is typically silent. An accurate evaluation of the extent of the disease is crucial for selecting the most appropriate treatment approach. Nuclear medicine imaging is increasingly being applied in oncological diagnostics, prompting ongoing research into renal cell carcinoma markers that could serve as a foundation for theranostic approaches in this disease. Positron emission tomography/computed tomography imaging with prostate-specific membrane antigen (PSMA) ligands has already demonstrated successful utility in diagnosis of other cancers, including prostate cancer and gliomas. Emerging evidence of high sensitivity and specificity in detecting renal cell carcinoma lesions provides a suitable foundation for its application in both the diagnosis and subsequent management of this malignancy. Methods: This systematic review synthesizes the current scientific evidence on the molecular imaging of renal cell carcinoma using PSMA ligands, emphasizing the potential future applications of this imaging marker in theranostic approaches. Results and Conclusions: Based on a systematic review of the literature, it appears that PET/CT with PSMA ligands has the potential to surpass traditional imaging techniques in diagnostic accuracy while also providing valuable prognostic information.

The article presents the course of treatment and rehabilitation of a 73-years old Covid-19 patient with severe hyponatremia due to persistent vomiting and diarrhea. In spite of the restoration of the water-electrolyte balance, the patient continued to show consciousness disturbances, psychomotor retardation and mild tetraparesis. Those deficits were interpreted as symptoms of 'brain fog' in the course of Covid-19 as well as manifestation of critical condition polyneuropathy. It was laboratory diagnostics, performed after the patient's discharge from the hospital, that revealed central pontine myelinolysis sustained by the patient in the course of the infection. The article describes neuroimaging changes on magnetic resonance imaging diffusion weighted imaging (MRI DWI) characteristic of central pontine myelinolysis which is a rare disease. In addition, the article describes subsequent stages in working on the improvement of the patient's psychomotor abilities and in encouraging the doctor to rationally supplement sodium deficits, in compliance with the guidelines, as well as argues for continuing research into CNS impairment in the course of Covid-19.

Pourazowe uszkodzenie mózgu (TBI) stanowi wyzwanie dla współczesnej medycyny z powodu znacznej częstości występowania, zróżnicowanego obrazu klinicznego oraz konieczności interdyscyplinarnego postępowania często obejmującego intensywną terapię, leczenie chirurgiczne, farmakologiczne, żywieniowe i rehabilitację. Pomimo postępu w uzyskiwanych wynikach leczenia ciężkich TBI wciąż wielu chorychwymaga długotrwałej opieki i nie odzyskuje pełnej samodzielności. Z tego powodu trwają badania nad nowymi terapiami, w tym nad leczeniem neuroprotekcyjnym, które mogłoby poprawić rokowanie po urazie mózgu zarówno na wczesnym, jak i późnym etapie leczenia. W artykule przedstawiono opis przypadku chorego z ciężkim TBI przebiegającym z długotrwałymi zaburzeniami świadomości, niedowładem czterokończynowym, padaczką pourazową pomimo wczesnej intensywnej terapii i rehabilitacji, którego stan znacząco poprawił się po zastosowaniu leku o działaniu neurotroficznym i neuroprotekcyjnym (cerebrolizyny) w połączeniu z intensywną rehabilitacją i terapią zajęciową. Multidyscyplinarne postępowanie oraz terapia multimodalna będąca połączeniem zróżnicowanych metod leczenia, w tym neuroprotekcyjnego w TBI, jest obiecującą strategią postępowania, które może znacząco przyczynić się do sukcesu terapeutycznego.

Cerebral amyloid angiopathy (CAA) is one form of disease of the small vessels of the brain and can cause frequent cerebral hemorrhages as well as other types of stroke. The aim of the study was to analyze the static and dynamic balance of the body and changes in the tension of selected muscles of the cervical spine in patients with CAA after stroke, depending on visual control or its absence, compared to healthy volunteers. Eight stroke patients and eight healthy subjects were examined. The functional Unterberger test and the Biodex SD platform were used to test the dynamic equilibrium, on which the static equilibrium was also assessed. Muscle tension was tested with the Luna EMG device. In static tests, the LC muscle (longus colli) was significantly more active with and without visual control (p = 0.016; p = 0.002), and in dynamic tests, significantly higher results for MOS (p = 0.046) were noted. The comparison of the groups led to the conclusion that the more functional deficits, the more difficult it is to keep balance, also with eye control.

MRI generated forces are the source of potential complications in patients with cardiac implantable electronic devices (CIED). The technological progress, and growing clinical evidence concerning the operation of the contemporary MR non-conditional CIEDs during MRI, have started to significantly change our every-day clinical practice. Nevertheless, a lot of patients who could have an MRI performed safely, still have been refused the examination. In many clinical situations, an MRI examination in a patient with a CIED is reasonable, and is linked to a negligible risk of complications if performed under strict precautions. The MagnaSave Registry that evaluated the influence of nonthoracic MRI on the function of MR non-conditional CIEDs, and numerous studies involving thoracic and non-thoracic MRIs in patients with legacy CIEDs, have confirmed the feasibility and safety of such examinations. In this article, practical tips aimed towards improving the safety of MRI in MR conditional and non-conditional CIED patients are largely based on the very recently released (2017) HRS expert consensus statement. Clinical data emphasize the necessity of making the MRI more accessible to CIED patients, also in the case of MR non-conditional systems or when the thorax MR imaging is clinically reasonable. This goal should be achieved by increasing the number of centers complying with respective recommendations and applying protocols that would guarantee the highest safety level. Further studies are warranted to assess safety issues related to the main current contraindication to MRI, i.e., the presence of abandoned leads.