Multiple myeloma (MM) is a clonal plasma cell proliferation disease characterized by an abnormal monoclonal protein, leading to specific-organ damage. Nowadays, significant knowledge about the pathophysiology and the treatment of MM has been gained. Unique lesions regarding reactive oxygen species (ROS) and reactive nitrogen species (RNS) production in MM's pathobiology have been reported due to new technologies. On the one hand, in most stages of MM, an overproduction of free radicals and a deregulation of the human antioxidant system can be found, leading to intense myeloma cell proliferation. On the other hand, in advanced disease with comorbidities, oxidative stress suppression leads to further growth of neoplastic clone. Novel agents that have been emerged for MM treatment, such as proteasome inhibitors, immunomodulatory drugs, epigenetic drugs and monoclonal antibodies have improved patients' survival and quality of life. These drugs increase oxidative stress, resulting in myeloma cell apoptosis, via activation of a molecular pathway called Unfolded Protein Response (UPR). Nowadays, the research focuses on the discovery of novel factors that can enhance their anti-myeloma effects, by modulation of oxidative stress.

Objective: Early diagnosis and treatment of metastatic pericardial disease are crucial to prevent the life-threatening complication of cardiac tamponade. Thin Layer Cytology (TLC), a widely adopted technique in cytology, has gained significant acceptance for most specimens. Our study aimed to assess the utility of TLC in diagnosing metastatic neoplasms and their origins in pericardial effusions, as well as monitoring response to chemotherapy. Methods: We examined 184 pericardial fluids collected by pericardiocentesis and processed using the ThinPrep liquid-based technique. Various immunocytochemical markers were used to determine the site of metastatic neoplasms. We also evaluated the response to therapy in 53 patients with lung and breast cancer. Results: Out of 184 specimens, 113 pericardial fluids were diagnosed as positive for malignancy, while 71 were negative. Twenty-three cases of unknown primary site were included in the total positive cases. Ninety cases positive for malignancy had a known primary site of origin, including 31 lung carcinomas, 22 breast carcinomas, 10 ovarian carcinomas, 6 T-cell lymphomas, 3 urinary bladder carcinomas, 4 renal carcinomas, 5 adenocarcinomas of the colon, 5 prostate carcinomas, 2 parotid adenocarcinomas, and 2 melanomas. Regarding the 53 cases with chemotherapy treatment, the cytologic examination of pericardial fluid showed a remarkable reduction in neoplastic burden after the third dose of cisplatin or thiotepa instilled into the pericardial cavity. ThinPrep provided excellent preservation of cytomorphological features, high cellularity per slide, and a clear background. This comprehensive analysis provides crucial information about the types and distribution of cancerous cells present in the samples. Conclusions: Thin Layer Cytology (TLC) is a valuable diagnostic tool for detecting metastatic pericardial malignancy. It allows the examination of exfoliated cells from the pericardial fluid, providing crucial information for diagnosis, management, and monitoring the acute responsiveness to intrapericardial chemotherapy. Immunocytochemistry (IHC) can identify specific markers for various types of cancer, enabling a more accurate diagnosis and guiding further treatment decisions.

Background: Diabetes management in patients with hematologic malignancies is challenging because of advanced age, multimorbidity, and cancer-related therapies. However, real-world evidence regarding glycemic control in this population remains limited. We aimed to evaluate glycemic control, glucose-lowering treatment patterns, and factors associated with tight glycemic control in patients with type 2 diabetes and hematologic malignancies. Methods: This retrospective cross-sectional study included 86 adults treated at a tertiary university hematology department. Demographic, clinical, laboratory, and treatment data were extracted from medical records. Low measured glycated hemoglobin (HbA1c) was defined as HbA1c <6.5%. Associated factors were examined using exploratory multivariable logistic regression. Results: The mean age was 75.0 ± 11.6 years; 48 patients (55.8%) were men. Among the 80 patients with available HbA1c measurements, the median HbA1c was 6.6% (interquartile range 6.0–7.2), and 37 (46.3%) had HbA1c <6.5%. Exploratory regression analyses suggested higher odds of HbA1c <6.5% with higher estimated glomerular filtration rate (adjusted odds ratio [OR], 1.03; 95% confidence interval [CI], 1.002–1.055; p = 0.035) and lower odds with diabetic vascular complications (adjusted OR, 0.30; 95% CI, 0.09–0.99; p = 0.048). At the alternative HbA1c threshold of <7.0%, corticosteroid exposure was associated with lower odds (adjusted OR, 0.35; 95% CI, 0.13–0.98; p = 0.046). Fifteen patients (18.8%) had HbA1c <6.5% while receiving insulin and/or a sulfonylurea. Conclusions: Low HbA1c values were common in this cohort, including among patients receiving insulin and/or sulfonylureas. These findings describe low measured HbA1c and associated treatment patterns but do not establish unnecessarily intensive treatment, clinical inappropriateness, hypoglycemia, or treatment-related harm. Prospective studies incorporating individualized treatment targets and documented hypoglycemia are needed to clarify their clinical significance.