Shadowing Practice: Multiple Myeloma - signs and symptoms, pathophysiology, treatment - Learn English Speaking with Video

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In this video we will talk about multiple myeloma, the signs, the symptoms, pathogenesis, diagnosis and treatment.

of multiple myeloma.

Multiple myeloma is a malignant disease of plasma cells in the bone marrow.

It is the second most common hematological cancer.

generally affecting older people.

There is no known genetic component.

hereditary genetic component or definitive environmental risk factors.

Let us see what some common signs and symptoms of multiple myeloma are.

So many patients present with back pain.

infections of the respiratory tract.

Anemia, which will result in tiredness and fatigue.

renal failure, And, proteinuria.

people Patients with multiple myeloma also suffer from fractures and dehydration.

And finally investigations including scans will show lytic bone lesions.

Looking at a vertebral, sorry,

looking at a vertebrae, and bone marrow we find that bone will suffer from lytic bone lesions.

The vertebrae is also a site for hematopoiesis, the production of cells, for the blood.

which arises from hemopoietic stem cells.

So if we were to zoom into the bow and marrow, Here we have a hemopoietic stem cell within the bone marrow.

Normally, the hemotopoietic stem cell will eventually make B cells and then plasma cells.

which will event where the plasma cells will Eventually, reside in the bone marrow.

Normally the bone marrow contains less than 5 % plasma cells.

which are the long -lived plasma cells, and these guys, they secrete antibodies, remember? plasma cell secreted antibodies to help fight against infection.

The antibodies secreted are normal, consisting of light and heavy chains.

Now, in multiple myeloma, the hemopoietic stem cell shifts production mainly to produce more B cells and then finally plasma cells.

Thus, in the bow marrow, we end up with more than 10 % plasma cells.

occupying the bone marrow.

And now these plasma cells, they secrete abnormal antibodies.

Thank you.

75 % of multiple myeloma cases the antibodies are abnormally produced in high amounts.

And plasma cells also produce just light chains.

So they all they produce abnormal antibodies and they produce light chains only.

and these light chains only that are being produced are called the para -proteins.

The main antibodies produced or that are found associated with multiple myeloma are high amounts of IgG and IgA.

Let us now look at at the pathogenesis.

pathophysiology and the interaction that occurs between these abnormally high amounts of plasma cells with other cells in the bone.

Firstly, we just need to recap some cells found in the bone and bone marrow.

So the bone contains a number of cells.

Osteoblasts are cells that build bone.

Osteoclasts are the cells that break down bone.

And then we have things called bone marrow stromal cells which regulate are hematopoiesis.

So looking at this diagrammatically, here we have osteoblast, an osteoblast which will secrete osteoids,

and which together with minerals, calcium and phosphate, they will form strong bones.

Osteoclasts, on the other hand, break down bone by secreting hydrochloric acid.

The breakdown of bone results in the release of calcium and the phosphate.

and the calcium here will enter the plasma, the blood.

The interesting thing is that osteoclast activation, so the bone breaking cells,

The bone breaking cell's activation is regulated by osteoblasts.

which express rank L.

When rank L binds to rank on osteoclasts, This will stimulate osteoclastic activity.

But osteoblasts also secrete another molecule called OPG.

which inhibit this interaction.

thus inhibits or decreases osteoclastic activity.

Now let me introduce the bone marrow cells and the pathophysiology of multiple myeloma.

The bone marrow stromal cells normally regulate our hematopoiesis, right?

But in multiple myeloma, these bone marrow stromal cells will interact with these Uh, cancerous cells through receptors and cytokines.

adhesion of multiple myelomal cells to the bone marrow stromal cells results in cytokine mediated cell growth.

survival drug resistance, and migration.

So essentially the bone marrow stromal cells helps the multiple myeloma cells survive and grow.

So when the multiple myeloma cells survive and grow, they then do other things.

that help themselves.

So, The multiple myeloma cells secrete many cytokines and they have some bad consequences for the body.

So for example, the multiple myeloma cells can secrete interleukin -3, which actually decreases osteoblastic activity.

by inhibiting osteoblast progenitor cells to become osteoblasts.

So basically it just decreases the production of osteoblasts Um...

The multiple myeloma cells also secrete DKK1, which inhibit OPG production by osteoblast,

thus resulting in an increase in osteoclastic activity.

Multiple myeloma cells also stimulate osteoclastic activity.

through MIP1 Alpha.

and through expression of rank ligand.

the osteoclast can self -stimulate itself.

and the multiple myeloma and the bone marrow stromal cells through interleukin 6.

So this whole basically the whole cycle Yeah.

This whole picture shows an amplification of multiple myeloma cells, osteoclastic activity, and a decrease in osteoblastic activity.

So osteoclastic activity is basically promoted and osteoblastic activity is reduced.

When osteoclastic activity is stimulated, this will result in bone breaking down.

An increase in osteoclastic activity will lead to fractures and lytic lesions.

and also will result in more calcium entering the body.

So in the blood again here, we have hypercalcemia.

which can cause nerve problems and dehydration.

In the blood, there is also paraproteinemia.

with bits of light chains floating around the paraproteinemia has some bad effects.

And remember, the light proteins, these paraproteins, are being produced by the multiple myelomal cells.

So these light chains, these paraproteins, are small enough to get filtered through the glomerulus of the kidneys.

and and it can lead to renal failure in 20 to 30 % of cases.

The light chains are also urinated out, they're peed out

which is a clinical feature of multiple myeloma when light chains are urinated It is known as Benz -Jones proteins.

Multiple myeloma, as I mentioned at the start, also leads to anemia and this is through several mechanisms.

Three.

The first is that there is a shift of hematopoietic stem cells from myeloid

progenitor to lymphoid progenitor to make more plasma cells.

2. Overproduction of plasma cells clog up the bone marrow, stopping red blood cells being formed and entering the plasma.

Three, there's also the kidney failure failing kidney which results in decreased erythropoiesis,

Um, erythropoietin production and so decrease in red blood cell production.

There are many investigations that can be performed in multiple myeloma.

to sort of rule out other problems.

and to confirm that it's multiple myeloma.

And these investigations include blood and urine tests.

In the blood test, we can detect anemia as a result of abnormal red blood cell level.

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we can see an increase in paraproteins, paraproteinemia, a decrease in normal antibodies,

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we see hypercalcemia as a result of increased breakdown of bone.

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we see increase in urea and nitrogenous basis as a result of renal failure, as well as an increase in creatinine,

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which is a measure of renal failure.

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uh, renal competency, I guess.

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Urine tests show urinary Benz Jones proteins, which are the light chains that are peed out, remember.

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And then bone investigations include bone aspiration, bone marrow biopsy, which can show more than 10 % plasma proteins in the bone marrow.

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X -rays can show osteoporosis and CT scans can show lesions of of the bone and soft tissue.

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So those are the investigations we can perform in multiple myeloma.

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The actual diagnosis of multiple myeloma is: One,

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the presence of monoclonal plasma cells in the bone marrow 10 % or greater.

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So this is through bone biopsy.

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Two.

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the presence of monoclonal antibodies, or you know, the paraproteins in serum or in urine.

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And three, one or more of the following.

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So I have an acronym HRAAL, or some people use CRAB, same thing.

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So I use HRAAL, H is for hypercalcemia, R is for renal failure, A is for anemia, and L is for lytic bone lesions.

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So that's how you diagnose it.

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And to treat multiple myeloma, chemotherapy and radiotherapy of the vertebrae, vertebral bodies or Uh, whichever,

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uh, wherever the plasma cells are located.

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the neoplastic plasma cells are located.

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So chemotherapy, and radiotherapy.

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And I won't go into more detail than that.

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Hope you enjoyed this video on multiple myeloma.

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Thanks for watching, bye.

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Thank you.

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Vocabulario y notas de pronunciación para esta lección

Este vídeo tiene 125 frases y 1359 palabras para practicar shadowing. La parte hablada dura 11:34. El hablante mantiene un ritmo constante de unas 118 palabras por minuto, cómodo para el shadowing. Solo el 68 % de las palabras está entre las 3.000 más comunes del inglés, por lo que el vocabulario es exigente.

Vocabulario clave de este vídeo

15 palabras menos comunes del vídeo, con su pronunciación y significado:

bone /boʊn/ (sustantivo) — hueso. A composite material consisting largely of calcium phosphate and collagen and making up the skeleton of most vertebrates.
marrow /ˈmæɹəʊ/ (sustantivo) — tuétano, meollo. The substance inside bones which produces blood cells.
plasma /ˈplæzmə/ (sustantivo) — plasma. A state of matter consisting of partially ionized gas and electrons.
decrease /dɪˈkɹiːs/ (verbo) — mermar[se], descrecer. Of a quantity, to become smaller.
rank /ˈɹæŋk/ (sustantivo) — fila. A row of people or things organized in a grid pattern, often soldiers.
calcium /ˈkælsi.əm/ (sustantivo) — calcio. The chemical element (symbol Ca) with atomic number 20: a soft, silvery-white alkaline earth metal which occurs naturally as carbonate in limestone and as…
stimulate /ˈstɪm.jəˌleɪt/ (verbo) — estimular. To encourage into action.
kidney /ˈkɪdni/ (sustantivo) — riñón. An organ in the body that filters the blood, producing urine.
regulate /ˈɹɛɡ.jə.leɪt/ (verbo) — reglamentar. To dictate policy.
urine /ˈjʊɹɪn/ (sustantivo) — orina, micción. Liquid waste consisting of water, salts, and urea, which is made in the kidneys, stored in the bladder, then released through the urethra.
abnormal /ˌæbˈnɔɹ.ml̩/ (adjetivo) — anormal. Not conforming to rule or system; deviating from the usual or normal type.
suffer /ˈsʌfɚ/ (verbo) — sufrir, penar. To undergo hardship.
genetic /d͡ʒəˈnɛt.ɪk/ (adjetivo) — genético. Relating to genetics or genes.
infection /ɪnˈfɛkʃən/ (sustantivo) — infección, infición. The act or process of infecting.
component /kəmˈpoʊ.nənt/ (sustantivo) — componente. A smaller, self-contained part of a larger entity. Often refers to a manufactured object that is part of a larger device.

Phrasal verbs que vas a escuchar

look at (verbo) — mirar, funar. To observe or watch.
break down (verbo) — descomponerse, averiarse. To stop functioning.
rule out (verbo) — descartar. To cross an item out by drawing a straight line through it, as with a ruler.
talk about (verbo) — hablar de, hablar sobre. Used to draw attention to the speaker's characterization of someone or something.

Pronunciación a tener en cuenta

Los sonidos de “th”: chemotherapy /ˌkiːməʊˈθɛɹəpi/, pathogenesis /ˌpæθ.ə(ʊ)ˈd͡ʒɛn.ə.sɪs/, erythropoietin /ɪˌɹɪθɹəˈpɔɪ.ɪtɪn/
Los sonidos de “sh” y “zh”: infection /ɪnˈfɛkʃən/, interaction /ˌɪn.təˈɹæk.ʃən/, activation /ˌæktəˈveɪʃən/, essentially /ɪˈsɛnʃəli/, associate /əˈsoʊʃi.ət/
Palabras largas — cuida el acento: interaction /ˌɪn.təˈɹæk.ʃən/, activation /ˌæktəˈveɪʃən/, chemotherapy /ˌkiːməʊˈθɛɹəpi/, essentially /ɪˈsɛnʃəli/, associate /əˈsoʊʃi.ət/

Cómo practicar con este vídeo

Escucha el vídeo entero una vez sin hablar y anota las palabras que no conoces.
Haz shadowing frase por frase a velocidad normal, repitiendo cada una hasta que tu ritmo coincida con el del hablante.
Grábate y compara con el original, prestando atención a palabras como bone, marrow, plasma.

Gramática en este vídeo

Las estructuras que más usa el hablante, con las palabras exactas del vídeo:

Estructura	En el vídeo
Voz pasiva be + participio pasado — importa lo que ocurre, no quién lo hace	being produced · are found · is regulated
Oraciones de relativo who / which + oración — información extra sobre una persona o cosa	Anemia, which will · osteoblast which will · proteins, which are

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Shadowing Practice: Multiple Myeloma - signs and symptoms, pathophysiology, treatment - Learn English Speaking with Video

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