Hasil untuk "Diseases of the blood and blood-forming organs"

V. Innao, A.P.M. Barbagallo, O. Bianco et al.

Introduction: Chronic Lymphocytic Leukemia (CLL) is the most common leukemia in Western countries, with age-related incidence and clinical heterogeneity. Evans Syndrome (ES), defined by the concurrent occurrence of immune thrombocytopenia (ITP) and autoimmune hemolytic anemia (AIHA), is a rare immune disorder often associated with lymphoproliferative diseases and potentially fatal outcomes. Management relies on expert consensus due to the lack of randomized trials. Standard CLL therapies include BTK inhibitors (BTKi) and the BCL2 inhibitor Venetoclax, often with anti-CD20 antibodies. When CLL progression is associated with immune cytopenias, immunosuppressive therapy is used, with CLL-directed treatment in refractory cases. To date, no reports have described ITP onset following Venetoclax in a patient with prior AIHA successfully treated with Zanubrutinib. Patients and Methods: We report the case of a 75-year-old man diagnosed in 2019 with asymptomatic CLL who, in 2021, developed steroid- and IVIG-refractory warm AIHA, treated with Bendamustine-Rituximab, achieving partial response. In July 2024, he showed rapid lymphocytosis progression (DT <2 months), splenomegaly (23 cm), thrombocytopenia (PLT 86×10⁹/L), and constitutional symptoms (Rai IV/Binet C). FISH was negative; IGHV unmutated, TP53 wild-type, CLL-IPI 6. Venetoclax-Rituximab (Murano protocol) was started. In week 2 of ramp-up, the patient developed spontaneous ecchymoses and gingival bleeding. Labs showed PLT 0×10⁹/L, Coombs-positive tests, Hb 10.7 g/dL, and a positive SARS-CoV-2 swab. Steroids and IVIG were ineffective. After swab negativization, Rituximab 375 mg/m² was administered weekly ×4 without response. He was referred to our ITP hub. Results: Romiplostim (Rom) was initiated at 3 μg/kg/week and increased by 2 μg/kg/week; Zanubrutinib (Zanu) 160 mg BID was added in week 2. Platelet and hemoglobin normalization occurred within 4 weeks. After 6 months, BTKi was continued at full dose and Rom reduced to 5 μg/kg/week. A 10-day BTKi interruption led to PLT drop (11×10⁹/L), reversed after Zanu reintroduction. The patient has since maintained a complete hematologic response with no adverse events (fig.1). Conclusion: TPO-RAs are effective in ITP. However, when ITP is secondary to CLL, targeting the underlying disease is crucial. BTKi have shown efficacy in ITP, as highlighted in the LUNA3 trial. This case supports the safety and efficacy of combining BTKi and TPO-RAs in refractory secondary ITP.  

Alexandre D´Agostini Zottis, Júlia Luiz Agostinho, Eduardo Ricardo Santana et al.

Resumo: Introdução/Justificativa: O câncer engloba mais de 100 tipos de doenças malignas caracterizadas pelo crescimento descontrolado de células, que podem invadir tecidos adjacentes ou se espalhar para outras partes do corpo. Há décadas, as nanopartículas magnéticas (NPMs) de óxido de ferro vêm sendo estudadas por apresentarem grande potencial para aplicações biomédicas, especialmente na oncologia, no uso de agentes de contraste para imagem por ressonância magnética no realçamento de contraste negativo nos tecidos com a presença de tumores e não tumorais, em magneto hipertermia para destruição seletiva de células cancerosas e atuando no transporte vetorizado de fármacos quimioterápicos. Independente de suas aplicações biomédicas, para evitar a aglomeração das NPMs em células, tecidos e órgãos, que pode levar a embolismos, é essencial recobri-las com materiais biocompatíveis e não citotóxicos. Poliésteres derivados de lactonas e macrolactonas, como o copoliéster poli(globalide-co-ε-caprolactona) (PGlCL), têm sido explorados devido à sua biocompatibilidade, hidrofilicidade e biodegradabilidade. Objetivos: Este trabalho teve como objetivo a modificação e a funcionalização do copoliéster PGICL com cisteína, a fim de atingir três objetivos associados a funcionalização das NPMs, que garantirão sua aplicação em nanomedicina, tais como: a) melhorar sua hidrofilicidade (diminuindo sua cristalinidade) para que seja carreado com mais facilidade no meio intracelular; b) permitir que grupos amina e tiol sejam pontos de ancoragem para constituírem partes de ligantes com receptores de superfície celular, tais como o ácido fólico (AF) que só são expressos em células tumorais e c) possibilitar a ligação desses grupos químicos em sistemas de ''drug-delivery'' com o análogo do AF, o quimioterápico metotrexato (MTX) para o tratamento de câncer de mama. Neste estudo, o PGlCL foi modificado com cisteína (PGlCL-Cys) e utilizado para recobrir NPMs de óxido de ferro (Fe3O4 - magnetita), visando futuramente em um segundo passo, a funcionalização com AF e MTX em aplicações como vetorização ativas em sistemas como “drug-delivery” e a posteriori, em ensaios in vitro de radiosensibilização em células de câncer de mama. Materiais e Métodos: Soluções de Fe³⁺ e Fe²⁺ em HCl. Sob refluxo, adicionaram-se H₂O aquecida, NH₄OH (30mL, pH10, 90°C), PGICL em etanol. Agitou-se 45min, purificou-se com imã, lavou-se e armazenou as NPMs. Resultados: A caracterização físico-química das NPMs recobertas com PGlCL-Cys foi realizada por espectroscopia no infravermelho, confirmando a presença de bandas características da cisteína (ligações C-S-C em 715,21 cm⁻¹ e C-N em 1573,1 cm⁻¹) e do recobrimento das NPMs (bandas de deformação angular da ligação Fe- O em 635,63 cm⁻¹ e ∼590 cm⁻¹, correspondentes aos sítios octaédricos e tetraédricos da magnetita, respectivamente). A Microscopia Eletrônica de Transmissão (MET) revelou que as NPMs de Fe3O4@PGlCL-Cys possuem um diâmetro médio de 11,44 nm e exibem comportamento superparamagnético. Conclusão: Conclui-se que o método de coprecipitação e a síntese do copoliéster modificado com cisteína (PGlCL-Cys) foi eficaz, produzindo NPMs estáveis e monodispersas de modo que serão realizados futuramente outras caracterizações físico-químcias para avançar os estudos em ensaios biológicos in vitro para citotoxicidade e biocompatibilidade a fim de serem aplicadas no diagnóstico e tratamento de câncer de mama.

Nicole DeMarco, Shannon Carpenter, Brian Lee

Yasmine Aramon, Andrea Pieragostini, Pierre Jean Francin et al.

Abstract The outcome of multiple myeloma (MM) has tremendously improved over the past decade, due to the development of efficient chemotherapy and mostly immunotherapy. Yet, some patients still display poor responses and outcome. This could be in part related to the presence of peripheral plasma cells, at levels not compatible with a diagnosis of plasma‐cell leukaemia. Some recent publications have highlighted the prognostic influence of low levels of such cells which is around 0.1%. Automated blood cell analysers now include fluorescent staining, allowing to identify cells with higher levels or nucleic acids such as activated B‐lymphocytes/plasma cells with highly active ribosomal activity related to antibody production. Here, a prospective evaluation of peripheral high fluorescent lymphoid cell (HFLC) levels was carried out on samples from patients with newly diagnosed MM, and data computed with regard to patient evolution. HFLC above a 0.1% threshold were identified as strongly correlated with poorer response in a cohort of 127 patients. The 74 patients with low HFLC had a significantly better PFS both in univariate (p = 0.0017) and multivariate (p = 0.0007) analyses. This simple test provides a significant prognostic value for patients with MM and could eventually lead clinicians to consider more aggressive strategies for patients with peripheral HFLC above 0.1%. Trial Registration: The authors have confirmed clinical trial registration is not needed for this submission

A. Perrotta, C. Causa, G. Petricciuolo et al.

Acute myeloid leukemia (AML) requires strict monitoring of minimal residual disease (MRD). We aimed to explore if MRD monitoring on peripheral blood (PB) represents a valid and less invasive alternative to repeated bone marrow (BM) aspirates in adults with AML undergoing allogeneic hematopoietic stem cell transplantation (HSCT) at Federico II University Hospital in Naples. Molecular markers to follow on PB included NPM1, WT1, CBF-AML, BCR-ABL, and PML-RARA. MRD positivity or biochemical/clinical suspicion of disease relapse prompted to BM aspirate. Forty-one patients (17 males and 24 females) underwent HSCT for AML between July 2020 and November 2024. Median age at transplant was 58 (range 30-72) years. MRD monitoring post-transplant was performed using NPM1 in 18, WT1 in 18, CBF-AML in 2, BCR-ABL in 2 and PML-RARA in 1 patient. Disease status at transplant was CR1 in 25, CR2 in 10 (including 6 with MRD+ at transplant) and active disease in 6 patients. Conditioning regimen was myeloablative, reduced-intensity or sequential in 20, 14 and 7 patients, respectively. Stem cell source was BM in 12 and PB in 29 cases. Donors were HLA-identical in 11, matched unrelated in 21, haploidentical in 9 cases. Graft-versus-host disease (GVHD) prophylaxis consisted of cyclosporine associated to mycophenolate mofetil (n=29) or methotrexate (n=12). ATG or PTCY were also used in 27 and 11 patients, respectively, while 3 received both. All patients achieved neutrophil engraftment with a median time of 14 (range 8-23) days. All but one patient achieved platelet engraftment with a median time of 14 (range 8-34) days. Grade II-IV acute GVHD occurred in 6 while chronic GVHD in 8 patients (mild, n=5; moderate, n=2; extensive, n=1). MRD positivity during follow-up was detected in 10 cases, with 3 contextual overt relapses on BM and one occurring one month later. Preemptive treatments were introduced in 6 cases. Later on, 2 patients experienced overt hematological relapse 15 and 12 months from previous molecular relapse while one patient experienced extramedullary relapse. Preemptive treatments were used in 6 cases, prophylactic treatments were used in 4, while 7 patients were treated for overt relapse. With a median follow-up of 23 (range 5-57) months, 2-year PFS and OS were 67±9% and 85±6%. In our experience, MRD monitoring using PB represented a sensitive strategy to detect molecular or overt relapse avoiding repeated bone marrow aspirations during the follow-up.

C. Tatarelli, M. Breccia, M. Santopietro et al.

Background With increasing life expectancy, there has been a progressive rise in the proportion of patients (pts) aged ≥80 years diagnosed with myeloproliferative neoplasms (MPNs). However, data specifically focusing on very elderly pts with polycythemia vera (PV) remain limited. Aim: To describe the clinical characteristics and disease course of PV in a real-life cohort of pts aged ≥80 years. Methods: Between 1/2000 and 06/2024, 125 consecutive pts aged ≥80 years were diagnosed with PV across nine hematology centers. These pts were enrolled in the retrospective and prospective databases of the Latial group for Ph-negative MPNs. Diagnoses were reviewed according to WHO 2022 criteria. Results: Main characteristics at diagnosis are shown in the Table. Bone marrow (BM) biopsy was performed in 18 of 114 evaluable pts (15.8%). Median JAK2 V617F allele burden was 38.8% (IQR 11.4–65). At diagnosis, symptoms were reported in 24 of 81 evaluable pts (29.6%), with pruritus present in 10 (41.6%). A history of thrombotic events was found in 33 pts (26.4%). Hydroxyurea (HU) was initiated in 121 pts, typically within one month from diagnosis (IQR 0.1–3.8). HU was discontinued in 23 pts (18.8%), mainly due to intolerance (16/23). Of these, only 3 pts (13%) received ruxolitinib as 2nd line therapy, while 13 (56.6%) received no further cytoreductive treatment. During follow-up, thrombotic events occurred in 11 pts (8.8%), and disease progression to fibrotic or blastic phase was observed in 4 cases. At the last follow-up, 34 pts had died, 33 were lost to follow-up, 58 were alive. The 60- and 120-month cumulative overall survival (OS) rates were 71% (95%CI 82.2–59.8) and 31.9% (95%CI 49.2–14.6), respectively. Conclusion: This real-life cohort study of very elderly PV patients reveals key insights into current clinical practice. BM biopsy was infrequently performed, and nearly all pts received HU promptly after diagnosis. However, there was a noticeable hesitancy in initiating 2nd line therapy with ruxolitinib following HU discontinuation. The high rate of pts lost to follow-up, likely due to challenges in accessing care, limits the robustness of survival analysis. Nevertheless, the observed OS was comparable to that of the general population in the same age group.  

Wolfgang Liedtke

K. Petrosyan, V. V. Krylov, A.V. Lugovaya et al.

Inflammatory joint diseases, such as rheumatoid, psoriatic, reactive arthritis, ankylosing spondylitis, reactive and other arthritis, lead to significant loss of quality of life and are frequent causes of disability. These diseases are accompanied by synovitis, which continues to progress despite the ongoing basic therapy. Radiosynovectomy (RSE) is one of the effective methods of treatment of such patients. A radiopharmaceutical drug based on human blood albumin microspheres with a diameter of 5-10 μm labeled with rhenium-188 for the treatment of knee arthrosis (Arthroren-MRRC) was developed at the A. Tsyb MRRC. The results of phase 1 clinical trials are presented, the aim of which is to study the tolerability, safety and pharmacokinetics of the drug during knee joint RSE (single intra-articular injection for the treatment of chronic recurrent synovitis); to study the increasing activities (370, 555, 740 and 925 MBq), to evaluate the radiation doses, the effect of RSE with the use of radiopharmaceutical on the quality of life of patients, radiation exposure to personnel. 20 patients (18-75 years old) with recurrent chronic synovitis of the knee joint underwent RSE with injection of Re-188 MCA 5-10 μm with activity ranging from 370 to 925 MBq. After injection, the following was performed: time-lapse SPECT/CT scintigraphy (1-72), radiometry of urine taken within 48 h after RSE and estimation of absorbed internal radiation doses to the synovial membrane and organs at risk. The absorbed doses formed after RSE in the knee joint in patients ranged from 17.5 to 74 Gy, and the doses to the organs at risk were many times lower than the generally accepted dose limits. High safety and good tolerability of radiopharmaceutical (188Re MCA 5-10 μm) was demonstrated. The activity of 740 MBq appeared to be optimal in terms of safety and efficacy in knee joint RSE.

Yi-Yuan Ge, Yan-Quan Lai, Ai-Ping Ju et al.

Objective The α-globin fusion gene between the HBA2 and HBAP1 genes, is clinically important in thalassemia screening because this fusion gene can cause severe hemoglobin (Hb) H disease when combined with α0 -thalassemia (α0 -thal). In this study, we evaluate the red blood cell parameters of α-thalassemia fusion gene in southern China.Method Study samples suspected of α-thalassemia fusion gene were collected and confirmed by PCR-sequencing from one medical lab center in southern China. Their genotypes and phenotypes were analyzed.Results A total of 266 cases of α-thalassemia fusion gene were confirmed in our lab from 2017 to 2023, most of them were from Hainan province (169 cases) and Huadu district of Guangzhou (21 cases), the nationality of 143 cases from Hainan was identified, with 71.3% (102/143) being from the Li minority. The Hb, MCV, MCH for αα/(αα)fusion in adult males were 143.5±11.83g/L, 81.51±4.39 fl, and 26.26±1.29 pg, respectively; and in females, they were 126.69±12.89 g/L, 80.10±4.05 fl, 25.8±2.04 pg, respectively. All 12 cases (αα) Fusion/ --SEA showed anemia with decreased Hb, MCV and MCH.Conclusion The carriers of α-globin fusion gene heterozygotes are clinically silent and exhibit an α+ phenotype. Individuals with (αα)Fusion/--SEA show apparent anemia. This α-globin fusion gene is relatively common in southern China, specifically among the Li minority of Hainan province. Therefore, it should be taken into account for genetic counseling purposes.

Andrew D. Leavitt, Johnny Mahlangu, Priyanka Raheja et al.

Background: Valoctocogene roxaparvovec, an adeno-associated virus-mediated gene therapy for severe hemophilia A, enables endogenous factor (F)VIII expression and provides bleed protection. Objectives: Determine valoctocogene roxaparvovec durability, efficacy, and safety 4 years after treatment. Methods: In the phase 3 GENEr8-1 trial, 134 adult male persons with severe hemophilia A without inhibitors and previously using FVIII prophylaxis received a 6 × 1013 vg/kg infusion of valoctocogene roxaparvovec. Efficacy endpoints included annualized bleed rate, annualized FVIII infusion rate, FVIII activity, and the Haemophilia-Specific Quality of Life Questionnaire for Adults. Adverse events and immunosuppressant use were assessed. Change from baseline was assessed after participants discontinued prophylaxis (scheduled for week 4). Results: Median follow-up was 214.3 weeks; 2 participants discontinued since the previous data cutoff. Declines from baseline in mean treated annualized bleed rate (−82.6%; P < .0001) and annualized FVIII infusion rate (−95.5%; P < .0001) were maintained from previous years in the primary analysis population of 112 participants who enrolled from a noninterventional study. During year 4, 81 of 110 rollover participants experienced 0 treated bleeds. Week 208 mean and median chromogenic FVIII activity were 16.1 IU/dL and 6.7 IU/dL, respectively, in 130 modified intention-to-treat participants. Seven participants resumed prophylaxis since the previous data cutoff. Mean change from baseline to week 208 in Haemophilia-Specific Quality of Life Questionnaire for Adults Total Score (P < .0001) remained clinically meaningful for modified intention-to-treat participants. Alanine aminotransferase elevation was the most common adverse event during year 4 (56/131 participants); none required immunosuppressants. Conclusion: Valoctocogene roxaparvovec provides persistent FVIII expression, hemostatic control, and health-related quality of life improvements with no new safety signals.

Moez Dawood, Ben Heavner, Marsha M. Wheeler et al.

Rare diseases are collectively common, affecting approximately one in twenty individuals worldwide. In recent years, rapid progress has been made in rare disease diagnostics due to advances in DNA sequencing, development of new computational and experimental approaches to prioritize genes and genetic variants, and increased global exchange of clinical and genetic data. However, more than half of individuals suspected to have a rare disease lack a genetic diagnosis. The Genomics Research to Elucidate the Genetics of Rare Diseases (GREGoR) Consortium was initiated to study thousands of challenging rare disease cases and families and apply, standardize, and evaluate emerging genomics technologies and analytics to accelerate their adoption in clinical practice. Further, all data generated, currently representing ~7500 individuals from ~3000 families, is rapidly made available to researchers worldwide via the Genomic Data Science Analysis, Visualization, and Informatics Lab-space (AnVIL) to catalyze global efforts to develop approaches for genetic diagnoses in rare diseases (https://gregorconsortium.org/data). The majority of these families have undergone prior clinical genetic testing but remained unsolved, with most being exome-negative. Here, we describe the collaborative research framework, datasets, and discoveries comprising GREGoR that will provide foundational resources and substrates for the future of rare disease genomics.

Jin Hyun Joh, Sun Hyung Joo

Cyanoacrylate glue is a non-thermal, non-tumescent agent used to treat saphenous reflux. It was introduced to overcome heat-related discomfort and complications. Multiple randomized controlled trials using this therapy have demonstrated excellent clinical outcomes at long-term follow-up. However, diffuse injection-site inflammation and systemic urticaria are worrisome complications. In preclinical studies, serial histopathological findings demonstrated acute inflammatory reaction, subacute vasculitis, chronic granulomatous foreign body reaction, fibrotic changes with partial vascular recanalization, and chronic foreign body-type inflammatory response. While the exact nature of this unique complication remains undefined, complex hypersensitivity and irritation reaction phenomena have been suggested based on reported clinical presentations. The incidence of this complication has been reported as ranging from 0.3%-25.4%. Typically, erythematous reactions can occur near treatment sites, with symptoms ranging from mild pruritus and/or erythema that resolves without treatment to recurrent severe inflammation and pruritus requiring nonsteroidal anti-inflammatory drugs, antihistamines, and/or corticosteroids. Surgical excision has been rarely reported in patients with severe intractable inflammation or treatment-site infections. Although several anecdotal studies reported on using antihistaminics or corticosteroids, no effective strategies have been established to prevent this complication.

Yan Gu, Chunhua Song, Sinisa Dovat et al.

Jerome Nango, J. C. Alico, Sié Ouattara et al.

The detection of red blood cells based on morphology and colorimetric appearance is very important in improving hematology diagnostics. There are automatons capable of detecting certain forms, but these have limitations with regard to the formal identification of red blood cells because they consider certain cells to be red blood cells when they are not and vice versa. Other automata have limitations in their operation because they do not cover a sufficient area of the blood smear. In spite of their performance, biologists have very often resorted to the manual analysis of blood smears under an optical microscope for a morphological and colorimetric study. In this paper, we present a new strategy for semi-automatic identification of red blood cells based on their isolation, their automatic color segmentation using Otsu's algorithm and their morphology. The algorithms of our method have been implemented in the programming environment of the scientific software MATLAB resulting in an artificial intelligence application. The application, once launched, allows the biologist to select a region of interest containing the erythrocyte to be characterized, then a set of attributes are computed extracted from this target red blood cell. These attributes include compactness, perimeter, area, morphology, white and red proportions of the erythrocyte, etc. The types of anemia treated in this work concern the iron-deficiency, sickle-cell or falciform, thalassemia, hemolytic, etc. forms. The results obtained are excellent because they highlight different forms of anemia contracted in a patient.

Katie S. Gatwood, Bhagirathbhai R. Dholaria, Mariana Lucena et al.

Abstract Adoptive cellular therapy has made a landmark change within the treatment paradigm of several hematologic malignancies, and novel cellular therapy products, such as chimeric antigen receptor T‐cell therapy (CART), have demonstrated impressive efficacy and produced durable responses. However, the CART treatment process is associated with significant toxicities, healthcare resource utilization, and financial burden. Most of these therapies have been administered in the inpatient setting due to their toxicity profile. Improved toxicity management strategies and a better understanding of cellular therapy processes are now established. Therefore, efforts to transition CART to the outpatient setting are warranted with the potential to translate into enhanced patient quality of life and cost savings. A successful launch of outpatient CART requires several components including a multidisciplinary cellular therapy team and an outpatient center with appropriate clinical space and personnel. Telemedicine should be incorporated for closer monitoring. Additionally, clear criteria for admission upon clinical decompensation, a pathway for prompt inpatient transition, and clear toxicity management guidelines should be implemented. Effective education about cellular therapy and toxicity management is imperative, especially for the Emergency Department and Intensive Care Unit teams. Here, we have outlined the various logistical and clinical considerations required for the care of CART patients, which will aid centers to establish an outpatient CART program.

K. Xenou, C. Sotiropoulou, P. Karousi et al.

D. yang, J. wen, Y. zhang et al.

Yuto Yokoyama, Akane Tanaka, Yoshiyuki Tagawa

Previous studies suggest that the behaviour of impacting blood is similar to that of a Newtonian fluid, which has a shear viscosity equivalent to that of blood at high shear rates. To understand this important fact, we conducted comparative experiments of droplet impact on a glass surface using whole blood and three solutions with a shear viscosity similar to that of blood. Specifically, we used dog's whole blood (deformable red blood cells dispersed in plasma, WB), plasma with non-deformable resin particles (PwP), glycerol and water with resin particles (GWwP), and a commercial blood simulant (hard particles dispersed in a water-based Newtonian solution, BS). The ranges of Reynolds and Weber numbers in our experiments were 550 $<Re<$ 1700 and 120 $<We<$ 860, respectively. Side and bottom views of droplet impact were simultaneously recorded by two high-speed cameras. The spreading radius of the impacting WB droplet in our experiments agreed well with that of Newtonian fluids with viscosity similar to that of WB at high shear rates. Splashing droplets of WB and Newtonian fluids form finger structures (finger-splashing). Although PwP has a viscosity similar to that of WB at high shear rates, an impacting PwP droplet exhibited typical characteristics of impacting suspension droplets, that is, a reduced spreading radius and splashing with ejection of particles. Such significant differences between impacting droplets of PwP and WB indicates that the high deformability of red blood cells in WB plays a crucial role in the Newtonian-like behaviour of blood droplets on impact. Importantly, the impacting BS droplet behaved quite differently from WB in both spreading and splashing. Our results imply that the use of deformable particles rather than hard particles in a BS is essential for mimicking blood droplet impact.

Gunardi Pome, Ira Kusumawaty, Yunike et al.

Diabetes mellitus is a disease caused by declining levels of insulin that is characterized by increased blood sugar levels that can cause some chronic diseases in some organs of the body. The problem in this case study is the non-compliance diet in diabetes mellitus type 2 patients. Non-compliance diet is the behavior of a person who does not follow the recommended diet by a physician or other health worker who can cause treatment results is not to be ineffective. This research aims to get an overview of the implementation of nursing health education in Diabetes mellitus type II patients with dieting problems. This method type of research is narrative in the form of literature studies. The article criteria/research results used in this study consist of 6 (six) articles/research results published online between 2015-2019. The articles/results of such studies are available in full text for researchers to use as data for analysis. The result this research is based on the results of previous research obtained and articles as a reference to literature study there is a way to reduce the problem of dietary disobedience in patients with type II of DM, one of them using the implementation of health education nursing. Health education is needed because DM disease is a lifestyle-related disease that needs an increase in knowledge to change lifestyles. Therefore, it is gained that knowledge is very influential about the diet adherence to DM patients type II and health education is the proper implementation to solve the problem.

Antony N. Beris, Jeffrey S. Horner, Soham Jariwala et al.

Due to the potential impact on the diagnosis and treatment of various cardiovascular diseases, work on the rheology of blood has significantly expanded in the last decade, both experimentally and theoretically. Experimentally, blood has been confirmed to demonstrate a variety of non-Newtonian rheological characteristics, including pseudoplasticity, viscoelasticity, and thixotropy. New rheological experiments and the development of more controlled experimental protocols on more extensive, broadly physiologically characterized, human blood samples demonstrate the sensitivity of aspects of hemorheology to several physiological factors. For example, at high shear rates to the red blood cells elastically deformation, imparting viscoelasticity, while and at low shear rates, they form rouleaux structures that impart additional, thixotropic behavior. In addition to these advances in experimental methods and validated data sets, significant advances have also been made in both microscopic simulations and macroscopic, continuum, modeling, as well as novel, multiscale approaches. We outline and evaluate the most promising of these recent advances. Although we primarily focus on human blood rheology, we also discuss recent observations on variations across some animal species that provide some indication on evolutionary effects.