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Paroxysmal nocturnal hemoglobinuria is a rare clonal hematopoietic stem cell disorder with debilitating health consequences if untreated. Although cases have been described globally, precise epidemiological distribution is difficult to assess due to geographical underrepresentation in disease reporting. Evaluation of the burden of paroxysmal nocturnal hemoglobinuria in Bulgaria is currently missing. To provide epidemiological estimates, a systematic literature search for publications in the Bulgarian language or by Bulgarian authors was performed for a ten-year period (2013-2022), and clinically relevant information on case presentation was collected. Additionally, data was retrieved from the National Health Insurance Fund and National Statistical Institute on the count of registered cases with ICD-10 code "D59.5" and census for the same period. The estimated prevalence of paroxysmal nocturnal hemoglobinuria is relatively lower in the Bulgarian population than in other countries, and it is estimated to be 2.77 cases per 1,000,000 patient years. The treatment pattern mainly shows conventional blood product support use and is consistent with the pre-complement inhibition era. Underdiagnosis, lack of a reliable disease reporting system, and, until recently, restricted access to complement inhibitor therapy are significant impediments to the management of paroxysmal nocturnal hemoglobinuria in Bulgaria., Competing Interests: The author has no conflicts of interest to disclose., (2024, International Research and Cooperation Association for Bio & Socio - Sciences Advancement.)

Alteration of urokinase plasminogen activator receptor (uPAR) in neoplasms is a prerequisite for invasiveness and metastatic ability. In the present study, we aimed to evaluate the relationship of pre-chemotherapy soluble uPAR (suPAR) with the odds for metastasis, lack of disease control, and its predictive ability for progression-free survival (PFS). Baseline plasma suPAR levels were measured by ELISA in 89 patients with various cancers prior to initiation of systemic treatment. Patients were followed prospectively until metastatic progression or death. TCGA Pan-Cancer dataset was mined for available RNAseq expression data of the PLAUR gene in patients with breast, colon, and lung cancer, and therelevant genomic and clinical data were extracted for further analysis. Pre-chemotherapy suPAR levels were significantly associated with white blood cell counts and fibrinogen and were significantly elevated both in patients with metastatic disease and in patients with progression. Increasing suPAR was significantly associated with odds for progression in the prespecified multivariate analysis (odds ratio 2.47, 95% confidence interval 1.3 - 5.11). In univariate Cox regression, suPAR was predictive of shortened progression-free survival (PFS) (hazard ratio 1.065, 95% confidence interval 1.002 - 1.13; p = 0.041). There was a trend towards shortened PFS in patients with higher baseline suPAR levels (cutoff 8.1 ng/mL). In the TCGA lung cancer cohort, PLAUR mRNA expression was significantly associated with shortened PFS in both univariate and multivariate analyses. High PLAUR gene expression conferred significant survival disadvantage only in patients with colon and lung cancer. SuPAR may bear predictive potential for adverse outcomes in cancer, but its utility as a biomarker seems to be more pronounced in cancers with associated inflammatory state.

Purpose: To look at the frequency of second primary malignancies (SECMAL) in patients with multiple myeloma (MM)., Methods: The medical files of 332 patients with MM (whole group), diagnosed and treated at the University Multiprofile Hospital for Active Treatment "Sv. Georgi" and the Comprehensive Oncology Hospital (Plovdiv) for a 20-year period (1990-2010) were retrospectively analyzed. MM patients with SECMAL constituted the study group. A control group comprised patients with solid tumors associated with SECMAL. This group derived from a sample of 21768 patients with solid tumors., Results: In the study group, SECMAL was diagnosed in 4.52% (N=15) of the patients, while in the control group this figure was 5.09% (N=1108) (p>0.05). The diagnosis of MM preceded the occurrence of SECMAL in 35.71% of the study group patients, the median interval being 6.6 years (range 5-14). More frequently the diagnosis of the solid tumor preceded the occurrence of MM (66.67%). Breast cancer and gastric cancer were encountered with the highest frequency (26.67% each). The median survival (77.2 months, range 44-129) was significantly longer in the group with MM and SECMAL compared to the whole group with MM (median 38.6 months, range 10-58; p<0.05)., Conclusion: The rate of MM with other malignant diseases is comparable with the frequency of SECMAL in other lymphoproliferative disorders and solid tumors. The occurrence of SECMAL during the clinical course of MM is not a frequent event and is expected in the rare cases with longer survival.

Tumor growth is characterized by disturbances of hemostatic mechanisms towards subclinical activation of coagulation. In cancer patients there is an increased risk up to 4-6 fold for developing idiopathic thrombosis due to the tumor-associated prothrombotic status. The molecular basis for the interrelationship between malignant phenotype and hemostatic disbalance includes several specific properties of tumor cells such as production of proinflammatory and proangiogenic cytokines, exhibition of procoagulant / fibrinolytic activities by tumor cells themselves and direct cell-to-cell interactions between tumor cells and cellular components of the hemostatic system. Aberrant tissue factor (TF) expression is a hallmark of human cancers and has been linked to their metastatic potential and neoangiogenesis. TF is a multifunctional molecule which controls the pro-/antiangiogenic balance in tumor tissue both by its procoagulant properties and via coagulation-independent mechanism inducing production of angiogenic cytokines by tumor cells. Components of the fibrinolytic system urokinase plasminogen activator (uPA) and urokinase plasminogen activator receptor (uPAR) facilitate targeted proteolysis of the basement matrix in order neovascularization to occur. Overexpression of these factors in tumor tissue has been identified as prognosticator for metastatic spread and overall survival in many human cancers, including breast, gastrointestinal, lung, urological and gynecological malignancies. Measurement of circulating TF and the soluble isoform of uPAR in plasma may be useful for evaluating the risk of cancer metastasis, monitoring for tumor recurrence and prediction of response to cancer therapy.

Angulometric teleroentgenographic characteristics of teeth were compared for 158 subjects. A computer technology of calculation and assessment of 47 angular (quantitative) parameters characterizing spatial position of the teeth and jaws is proposed. This complex of parameters can be used as an additional test in personal identification.