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This article examines how illiberal leaders’ behaviour towards the judiciary changes when they have a second chance in power. Drawing on Varieties of Democracy indicators for populist rhetoric and constitutional change, we identify several OECD worst performers and focus on two – Poland and Hungary – whose illiberal leaders ascended to power for a second time. For Hungary, we examine PM Orbán’s first time in office, time in opposition and second time in office, when he undertook reforms of the Constitutional Court, Supreme Court and other courts. For Poland, we examine the Kaczyńskis’ party’s first time in office, opposition and return to power, when it undertook campaigns against a variety of constitutional institutions. We find the first mandate of such leaders is characterised by strong rhetoric and chaos, they consolidate control of their party while out of power, and in their second mandates they are much more effective and extreme in undermining judicial independence and the rule of law. The experiences of Poland and Hungary have important implications for the United States. In his first term, Donald Trump undertook various actions that undermined the judiciary, and his actions while out of office align with those of Orbán and Kaczyński, such that Trump’s second term might well pose a significant threat to the US judiciary.

It is my contention that populism could be an appropriate framework to describe, explain and connect the phenomena of global crisis of democracy and functioning of electoral autocracies. In order to substantiate this claim, with the method of literature review, I examine first the characteristics of these phenomena. Then I focus on the nature of the relationship between them, in particular on the complex system of new types of autocracies’ stability, in which populism could play a crucial role. Populism, understood as an autocratic (re-)interpretation of democracy and representation, could be a particularly dangerous Trojan Horse for democracy. First and foremost, because its idea of a single, homogeneous and authentic people that can be legitimately represented only by the populist leader is a moralised form of antipluralism which is contrary to the pluralist approach of democracy (i.e. polyarchy). For precisely this reason, populism could play a key role in autocracies, especial in electoral autocracies which may use its core elements. Namely, the Manichean worldview, the image of a homogeneous people, people-centrism and the autocratic notion of representation are very compatible with electoral autocracies, since these regimes hold general elections and their power is built largely upon the alleged will of the people. By using populism, it is possible for these regimes to camouflage and even legitimise their autocratic trends and exercise of power behind the formally multi-party but not fair elections and democratic façade. As a radical turn towards closed autocracies (without de facto multiparty elections) would be too expensive, electoral autocrats need manipulated multi-party elections and other plebiscite techniques that could serve as quasi-democratic legitimation. Because of this, they tend to use the political logic of populism which could transform political contestation to a life- and- death struggle and provides quasi-democratic legitimation and other important cognitive functions. Therefore, populist electoral autocracies, as a paradigmatic type of electoral autocracies, could remain with us for a long time, giving more and more tasks to researchers, especially in the Central and Eastern European region.

Background: Nowadays, cytogenetics and molecular genetics, but not only, are mandatory in acute myeloid leukemia (AML) management, as a consequence of their impact on AML pathogenesis, classification, risk-stratification, prognosis and treatment. Objective: The aim of our study was to present our algorithm for the analysis of copy number changes, aneuploidies and somatic mutations focusing on a rare AML case positive for four somatic mutations. Methods: Cytogenetic analysis, Multiplex Ligationdependent Probe Amplification (MLPA) analysis, somatic mutation analysis (for FLT3 ITD, FLT3 D835, DNMT3A R882 and NPM1 c.863_864ins) by using several PCR techniques and also next-generation sequencing (NGS) analysis were performed. Results: Cytogenetic analysis did not reveal structural or numerical chromosomal anomalies. The patient’s DNA showed no copy number changes or aberrations (CNAs) following the MLPA analysis. By using several molecular technologies we found four mutations: FLT3-ITD, FLT3 D835 (c.2504A>T, D835V), DNMT3A R882C, and NPM1 c.863_864insTCTG. Challenges, benefits, applications and the limitations of each molecular technique used for the investigation of the mentioned mutation, and not only, are also described. Conclusion: All these techniques can be useful in the diagnosis of AML patients, each of them covering the limits of the other technique. New strategies for a positive, fast, accurate and reliable diagnosis are mandatory in cases with AML.

Background: Lacrimal drainage system lymphomas are rare, accounting for less than 10% of lacrimal sac tumors. They often appear as a secondary involvement within the confines of systemic lymphoproliferative disorders, therefore detailed ophthalmological examination and auxiliary testing is necessary to have an accurate diagnosis.

Recent studies demonstrated that despite restoration of the sinus rhythm, patients with a positive history of atrial fibrillation (AF) are still at risk of thromboembolic events. The primary objective of this study is to identify new imaging-derived biomarkers provided by modern imaging technologies, such as cardiac computed tomography angiography, delayed enhancement magnetic resonance imaging, or speckle tracking echocardiography, as well as hematological biomarkers, associated with the risk of intracavitary thrombosis in patients with AF, in order to identify the imaging-derived characteristics associated with an increased risk of cardioembolic events. Imaging data collected will be post-processed using advanced techniques of computational modeling, in order to fully characterize the degree of structural remodeling and the amount of atrial fibrosis. The primary endpoint of the study is represented by the rate of thromboembolic events. The rate of cardiovascular death, the rate of major adverse cardiovascular events, and the rate of AF recurrence will also be determined in relation to the degree of structural remodeling and atrial fibrosis.

Background: Myocardial revascularization procedures have undergone important developments over the last decades, which led to a major shift in current clinical practice and therapeutic guidelines across the world. Bare metal and drug-eluting stents present several limitations, all centered on the concept of disturbed coronary hemodynamics after implantation, which can be surpassed by bioresorbable vascular scaffolds (BVS). BVSs are fourth-generation stents used in coronary revascularization procedures, but despite all the promising initial results published on their efficiency, several clinical trials have reported unsatisfactory results, and the main explanation was accredited to improper implantation method. Shear stress is a central element of intravascular homeostasis; it controls vascular remodeling, as well as the development, progression, and destabilization of atheromatous plaques. This study aims to assess the role of in-stent flow hemodynamics (evaluated by computational determination of shear stress via coronary CT imaging) in predicting the clinical evolution following BVS implantation.

Iron deficiency and anemia affect approximately half of the chronic heart failure patients and they are associated with increased hospitalization rate, lower functional capacity, lower quality of life, and higher mortality. The exact mechanism of iron deficiency in heart failure patients is still not fully understood. Current guidelines recommend ferritin as the most accurate serum biomarker for the diagnosis of iron deficiency. The use of erythropoiesis-stimulating agents is no longer recommended because of the lack of improvement on mortality or hospital readmission rate, and it was associated with a higher rate of thromboembolic events. Intravenous iron replacement therapy is safe and generally well tolerated, with fewer side effects compared to oral administration. Large randomized studies with ferric carboxymaltose demonstrated its effectiveness and superiority to oral administration, and it was associated with a decreased rate of hospitalization rate and worsening heart failure, and improvement of functional capacity and quality of life. Intravenous iron supplementation for chronic heart failure is strongly recommended by European guidelines. Further studies are needed for a better knowledge of this complex pathology and determination of the long-term safety and effectiveness of iron administration in chronic heart failure patients. .

Atrial fibrillation is the most frequent arrhythmia in adults, becoming more frequent with age. Recent clinical studies demonstrated that epicardial fat is linked with atrial fibrillation induction and recurrence. The arrhythmogenic mechanism consists in the fact that the epicardial adipose tissue is metabolically active, inducing local inflammation and enhancing the oxidative stress, which lead to atrial fibrillation as well as atherosclerosis. Having metabolic activity and secreting various anti- and pro-inflammatory biomarkers, the fat surrounding the heart has been linked to the complex process of coronary plaque vulnerabilization. This clinical update aims to summarize the role of epicardial adipose tissue in the pathogenesis, persistence, and severity of atrial fibrillation.

In Western countries, chronic lymphocytic leukemia (CLL) is one of the most diagnosed leukemia types among elderly patients. CLL is described as an indolent lymphoproliferative disorder, characterized by the presence of a high number of small, mature B-cells in the peripheral blood smear, with a particular immunophenotype (CD5, CD19, CD23 positive and CD20 dim positive) and accumulation in the bone marrow and lymphoid tissue (e.g., lymph nodes, spleen). The experience of the past decades showed that CLL is clinically very heterogeneous; while some patients present a chronic clinical evolution, with a prolonged survival, in which the treatment can be delayed, others suffer from a more aggressive form, which must be treated early and is associated with many relapses. This observation led to several genomic studies that have mapped the genetic modifications involved in the disease conformations, including del(13q14), del(11q), or trisomy 12. On the other hand, certain genetic mutations such as del(17p13)–p53, NOTCH1 mutation, or ZAP70/CD38 increased expression are associated with worse clinical outcome. In order to apply the right treatment strategy, the RAI and BINET staging systems should be considered, which are based on clinical and laboratory assessment, on genetic mutations that may influence the resistance to chemotherapy, as well as the patient’s age and comorbidities. The aim of this manuscript was to present the therapeutic approaches of CLL, in order to attempt to answer the following question: to treat, or not to treat? This clinical update focuses on the managements of CLL patients in the 21st century.

Peripheral artery diseases include all arterial diseases with the exception of coronary and aortic involvement, more specifically diseases of the extracranial carotids, upper limb arteries, mesenteric and renal vessels, and last but not least, lower limb arteries. Mononuclear stem cells, harvested from various sites (bone marrow, peripheral blood, mesenchymal cells, adipose-derived stem cells) have been studied as a treatment option for alleviating symptoms in peripheral artery disease, as potential stimulators for therapeutic angiogenesis, thus improving vascularization of the ischemic tissue. The aim of this manuscript was to review current medical literature on a novel treatment method — cell therapy, in patients with various peripheral vascular diseases, including carotid, renal, mesenteric artery disease, thromboangiitis obliterans, as well as upper and lower limb artery disease.

Wound healing is a complex restorative process of the altered cutaneous tissue, which is impaired by numerous local and systemic factors, leading to chronic non-healing lesions with few efficient therapeutic options. Stem cells possess the capacity to differentiate into various types of cell lines. Furthermore, stem cells are able to secrete cytokines and growth factors, modulating inflammation and ultimately leading to angiogenesis, fibrogenesis, and epithelization. Because of their paracrine activity, these cells are able to attract other cell types to the base of the wound, improving the formation of new skin layers. Mesenchymal stem cells derived from the adipose tissue, bone marrow, and placenta, offer numerous ways of implementation. The process of harvesting, growing, and administrating stem cells depends on the site and type of the cells, but recent trial results showed improvement of wound healing independent of the administration site. Bioengineered skin substitutes are validated for treatment of chronic wounds with direct application on the skin surface. These offer physical scaffolding for the migrating cells and promote secretion of growth factors, thus facilitating rapid wound healing. Obtaining further clinical data is essential, but stem cell therapy may become a first-line therapeutic choice for the treatment of non-healing chronic wounds.

Multiple myeloma accounts for 10% of the hematologic malignancies and is characterized by a single clone of plasma cells producing a monoclonal protein. The aim of this review is to summarize the current treatment methods of multiple myeloma. In the last 15 years, the incidence of myeloma has increased in patients younger than 65 years, thus treatment became even more important in order to obtain a long lasting remission or plateau phase. The treatment of this disease is complex and focuses not only on increasing the patients’ survival, but also improving their quality of life.

Chronic myeloid leukemia (CML) is a clonal myeloproliferative disorder, which can involve the hematopoietic stem cell or early progenitor cells, without the loss of their capacity to differentiate. Typically, CML has three clinical phases: a chronic phase, an accelerated phase, and an aggressive transformation in blast crisis, analogous to acute leukemia. The following article presents the case of a 49-year-old patient diagnosed with Philadelphia-negative CML in blastic transformation, where after multiple conventional acute leukemia induction chemotherapy regimens an unrelated allogeneic hematopoietic stem cell transplant was performed.

Despite of numerous treatment strategies developed in the last years, ischemic heart disease remains the leading cause of death around the world. Acute myocardial infarction (MI) causes irreversible destruction to the myocardial tissue, which is replaced by fibroblast cells, leading to the formation of a dense, collagenous scar, a non-contractile tissue, and often to heart failure. Stem cell therapy seems to represent the next therapeutic method for the treatment of heart failure caused by myocardial infarction. Several international trials proved the beneficial outcome of the intracoronary infusion of bone marrow-derived stem cells, improving left ventricular systolic function and clinical symptomatology. Many noninvasive imaging procedures are available to evaluate the beneficial properties of stem cell therapy. Most studies have demonstrated the role of multislice computed tomography (MSCT) in evaluating left ventricular parameters such as end-diastolic and end-systolic volumes and ejection fraction, or to quantify myocardial scar tissue. In this review we will discuss the usefulness of MSCT for the assessment of coronary arteries, new tissue regeneration, and evaluation of tissue changes and their functional consequences in subjects undergoing stem cell treatment following MI.

Stem cell-based therapy is a new therapeutic option that can be used in patients with cardiac diseases caused by myocardial injury. Cardiac magnetic resonance imaging (MRI) is a new noninvasive imaging method with an increasingly widespread indication. The aim of this review was to evaluate the role of cardiac MRI in patients with myocardial infarction undergoing stem cell therapy. We studied the role of MRI in the assessment of myocardial viability, stem cell tracking, assessment of cell survival rate, and monitoring of the long-term effects of stem cell therapy. Based on the current knowledge in this field, this noninvasive, in vivo cardiac imaging technique has a large indication in this group of patients and plays an important role in all stages of stem cell therapy, from the indication to the long-term follow-up of patients.

Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma (NHL), representing up to 30 percent of all lymphomas. DLBCL is a fast-growing, aggressive form of NHL, which can appear as a transformation from a less aggressive form of lymphoma or can be de novo pathology. The following article describes the case of a 55-year-old female patient who developed a DLBCL as a second malignancy after an R-CHOP-treated marginal zone splenic lymphoma. This was followed by the transformation of the DLBCL into an aggressive acute lymphoblastic leukemia, for which the patient needed aggressive treatment according to the international acute lymphoblastic leukemia protocol.

Hematological conditions and their treatments have an increased risk of cardiovascular events, and invasive interventions have a higher risk of periprocedural complications in this group of patients. The aim of this review was to evaluate the risk of invasive interventions in patients with hematologic disorders and to underline the role of noninvasive cardiovascular screening in patients with hematological disorders such as Hodgkin and non-Hodgkin lymphoma, anemia, hemophilia, thrombocythemia, polycythemia vera, and leukemia. Based on present knowledge in the field, our opinion is that the screening of patients with hematological diseases is very important to reduce the morbidity and mortality due to cardiovascular events. Noninvasive assessments are suitable for this purpose with a significantly lower risk compared to invasive interventions.

This study presents a new method of combined growth factor mobilization with increased dose (15 μg/kg) of filgrastim and standard mono dose of plerixafor in subjects with multiple myeloma, Hodgkin or non-Hodgkin lymphoma. Efficient mobilization is a key factor in the treatment of this group of patients, because autologous transplantation can be performed in cases in which we succeed to obtain a minimally sufficient number of stem cells. Autologous stem cell transplantation is included in the current standard treatment of multiple myeloma and in the relapsed cases of lymphomas.

We present the method of immunomagnetic stem cell separation with the ISOLEX 300i device (Isolex® 300i Magnetic Cell Selection System, Nextell Therapeutics Inc. Irvine California 21618 USA) and the results obtained using this method in patients admitted to the Hematology and Bone Marrow Transplantation Clinic of Tîrgu Mureş, Romania. Cell selection has a great importance in separating stem cells from tumor cells, therefore contributing to the success of autologous stem cell transplantation.

Hematological conditions can lead to serious disturbances in blood rheology, being frequently associated with increased systemic inflammation and increased risk of bleeding. The imbalance between coagulation and thrombolytic factors in patients with acute coronary syndromes may lead to undesirable outcomes, and the success of emergency coronary angioplasty or by-pass grafting may be altered by increased bleeding in coagulopathies such as hemophilia. This paper intends to review the present knowledge in the field of acute coronary syndromes in subjects with hematological and onco-hematological disorders such as thrombotic thrombocytopenic purpura, immune thrombocytopenic purpura, von Willebrand disease, hemophilia, polycythemia vera, erythrocyte disorders, myelodysplastic syndrome, leukemia, lymphoma or myeloma.

Acute myeloid leukemia (AML) is a cancerous disease affecting the myeloid line of the bone marrow cells. FLT3, also known as CD135, is a proto-oncogene, which, if mutated, leads to different types of cancer. The protein it encodes presents tyrosine-kinase activity, and its intratandem mutation, FLT3-ITD, leads to uncontrolled proliferation of myeloblasts and worse outcomes in AML patients. There are currently several pharmacological agents that can inhibit the effect of either the proteins with tyrosine-kinase activity or the mutated FLT3 gene. We present the case of a 68-year-old patient, smoker, with a history of arterial hypertension, chronic obstructive pulmonary disease, presenting with headache unresponsive to antalgics, dyspnea after physical exertion, and epistaxis, with onset 2 months prior to his presentation. The patient was diagnosed with AML with positive FTL3 mutation for which conventional induction therapy was initiated. Within the next days, the patient presented several complications related to the disease itself or caused by the treatment, which eventually led to his death.

Introduction: Autologous hematopoietic stem cell transplantation (ASCT) represents a standard therapy in the management of hematologic malignancies such as malignant lymphomas and has used for approximately three decades. The aim of this study was to determine the occurring post-ASCT complications and their impact on the patients’ recovery for a better management.

Background: High-dose chemotherapy and autologous stem cell transplantation have become a standard curative treatment in various hematologic malignancies. Many factors can affect the success of mobilization and hematopoietic stem cell harvesting.

Stem cells are undifferentiated cells that can divide and become differentiated. Hematopoietic stem cells cannot transform into new stem cells such as cardiomyocytes or new heart valves, but they act through paracrine effects, by secreting cytokines and growth factors that lead to an increase in contractility and overall improved function. In this case report, we present how autologous stem cell transplantation can bring two major benefits: the first refers to hematological malignancy and the second is about the improvement of the heart condition. We present the case of a 60-year-old patient diagnosed with multiple myeloma suffering from a bi-valve severe condition in which autologous stem cell transplantation led to the remission of the patient’s malignant disease and also improved the heart function.

Plasma cell leukemia (PCL) is one of the most aggressive monoclonal gammopathies, being characterized by the presence of more than 20% of plasma cells in the peripheral blood and an absolute number of these cells of more than 2×109, with different morphology, from young elements to mature cells. The incidence of PCL varies between 2–4% among multiple myeloma (MM) patients. In comparison with MM, PCL appears more often in younger patients. The following article describes the case of a 49-year-old female patient diagnosed with PCL which needed urgent control of the clinical manifestations due to its irreversible complications. Urgent autologous stem cell transplantation is recommended in this group of patients.

Multiple myeloma represents a challenge for hematologists because it has become more frequent at a young age in recent years. This is why autologous stem cell transplantation is included in the standard treatment of myeloma patients. We present the case of a 39-year-old patient who was diagnosed with non-secretory myeloma with double autologous transplantation and underwent neurosurgery for spinal cord compression caused by a plasmocytoma at D5 level. We present the evolution and complexity of this very difficult case.