Pratique du Shadowing: Multiple Myeloma - signs and symptoms, pathophysiology, treatment - Apprendre l'anglais à l'oral avec la vidéo
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In this video we will talk about multiple myeloma, the signs, the symptoms, pathogenesis, diagnosis and treatment.
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of multiple myeloma.
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Multiple myeloma is a malignant disease of plasma cells in the bone marrow.
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It is the second most common hematological cancer.
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generally affecting older people.
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There is no known genetic component.
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hereditary genetic component or definitive environmental risk factors.
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Let us see what some common signs and symptoms of multiple myeloma are.
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So many patients present with back pain.
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infections of the respiratory tract.
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Anemia, which will result in tiredness and fatigue.
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renal failure, And, proteinuria.
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people Patients with multiple myeloma also suffer from fractures and dehydration.
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And finally investigations including scans will show lytic bone lesions.
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Looking at a vertebral, sorry,
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looking at a vertebrae, and bone marrow we find that bone will suffer from lytic bone lesions.
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The vertebrae is also a site for hematopoiesis, the production of cells, for the blood.
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which arises from hemopoietic stem cells.
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So if we were to zoom into the bow and marrow, Here we have a hemopoietic stem cell within the bone marrow.
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Normally, the hemotopoietic stem cell will eventually make B cells and then plasma cells.
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which will event where the plasma cells will Eventually, reside in the bone marrow.
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Normally the bone marrow contains less than 5 % plasma cells.
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which are the long -lived plasma cells, and these guys, they secrete antibodies, remember? plasma cell secreted antibodies to help fight against infection.
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The antibodies secreted are normal, consisting of light and heavy chains.
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Now, in multiple myeloma, the hemopoietic stem cell shifts production mainly to produce more B cells and then finally plasma cells.
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Thus, in the bow marrow, we end up with more than 10 % plasma cells.
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occupying the bone marrow.
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And now these plasma cells, they secrete abnormal antibodies.
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Thank you.
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75 % of multiple myeloma cases the antibodies are abnormally produced in high amounts.
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And plasma cells also produce just light chains.
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So they all they produce abnormal antibodies and they produce light chains only.
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and these light chains only that are being produced are called the para -proteins.
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The main antibodies produced or that are found associated with multiple myeloma are high amounts of IgG and IgA.
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Let us now look at at the pathogenesis.
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pathophysiology and the interaction that occurs between these abnormally high amounts of plasma cells with other cells in the bone.
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Firstly, we just need to recap some cells found in the bone and bone marrow.
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So the bone contains a number of cells.
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Osteoblasts are cells that build bone.
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Osteoclasts are the cells that break down bone.
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And then we have things called bone marrow stromal cells which regulate are hematopoiesis.
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So looking at this diagrammatically, here we have osteoblast, an osteoblast which will secrete osteoids,
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and which together with minerals, calcium and phosphate, they will form strong bones.
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Osteoclasts, on the other hand, break down bone by secreting hydrochloric acid.
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The breakdown of bone results in the release of calcium and the phosphate.
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and the calcium here will enter the plasma, the blood.
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The interesting thing is that osteoclast activation, so the bone breaking cells,
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The bone breaking cell's activation is regulated by osteoblasts.
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which express rank L.
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When rank L binds to rank on osteoclasts, This will stimulate osteoclastic activity.
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But osteoblasts also secrete another molecule called OPG.
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which inhibit this interaction.
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thus inhibits or decreases osteoclastic activity.
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Now let me introduce the bone marrow cells and the pathophysiology of multiple myeloma.
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The bone marrow stromal cells normally regulate our hematopoiesis, right?
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But in multiple myeloma, these bone marrow stromal cells will interact with these Uh, cancerous cells through receptors and cytokines.
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adhesion of multiple myelomal cells to the bone marrow stromal cells results in cytokine mediated cell growth.
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survival drug resistance, and migration.
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So essentially the bone marrow stromal cells helps the multiple myeloma cells survive and grow.
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So when the multiple myeloma cells survive and grow, they then do other things.
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that help themselves.
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So, The multiple myeloma cells secrete many cytokines and they have some bad consequences for the body.
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So for example, the multiple myeloma cells can secrete interleukin -3, which actually decreases osteoblastic activity.
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by inhibiting osteoblast progenitor cells to become osteoblasts.
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So basically it just decreases the production of osteoblasts Um...
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The multiple myeloma cells also secrete DKK1, which inhibit OPG production by osteoblast,
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thus resulting in an increase in osteoclastic activity.
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Multiple myeloma cells also stimulate osteoclastic activity.
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through MIP1 Alpha.
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and through expression of rank ligand.
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the osteoclast can self -stimulate itself.
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and the multiple myeloma and the bone marrow stromal cells through interleukin 6.
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So this whole basically the whole cycle Yeah.
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This whole picture shows an amplification of multiple myeloma cells, osteoclastic activity, and a decrease in osteoblastic activity.
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So osteoclastic activity is basically promoted and osteoblastic activity is reduced.
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When osteoclastic activity is stimulated, this will result in bone breaking down.
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An increase in osteoclastic activity will lead to fractures and lytic lesions.
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and also will result in more calcium entering the body.
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So in the blood again here, we have hypercalcemia.
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which can cause nerve problems and dehydration.
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In the blood, there is also paraproteinemia.
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with bits of light chains floating around the paraproteinemia has some bad effects.
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And remember, the light proteins, these paraproteins, are being produced by the multiple myelomal cells.
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So these light chains, these paraproteins, are small enough to get filtered through the glomerulus of the kidneys.
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and and it can lead to renal failure in 20 to 30 % of cases.
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The light chains are also urinated out, they're peed out
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which is a clinical feature of multiple myeloma when light chains are urinated It is known as Benz -Jones proteins.
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Multiple myeloma, as I mentioned at the start, also leads to anemia and this is through several mechanisms.
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Three.
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The first is that there is a shift of hematopoietic stem cells from myeloid
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progenitor to lymphoid progenitor to make more plasma cells.
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2. Overproduction of plasma cells clog up the bone marrow, stopping red blood cells being formed and entering the plasma.
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Three, there's also the kidney failure failing kidney which results in decreased erythropoiesis,
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Um, erythropoietin production and so decrease in red blood cell production.
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There are many investigations that can be performed in multiple myeloma.
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to sort of rule out other problems.
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and to confirm that it's multiple myeloma.
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And these investigations include blood and urine tests.
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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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Vocabulaire et conseils d’expression pour cette leçon
Cette vidéo contient 125 phrases et 1359 mots à répéter en shadowing. La partie parlée dure 11:34. Le locuteur parle à un rythme régulier d’environ 118 mots par minute, confortable pour le shadowing. Seuls 68 % des mots font partie des 3 000 mots les plus courants en anglais, le vocabulaire est donc exigeant.
Vocabulaire clé de cette vidéo
15 mots moins courants de la vidéo, avec leur prononciation et leur sens :
- bone /boʊn/ (nom) — os. A composite material consisting largely of calcium phosphate and collagen and making up the skeleton of most vertebrates.
- marrow /ˈmæɹəʊ/ (nom) — moelle, moelle osseuse. The substance inside bones which produces blood cells.
- plasma /ˈplæzmə/ (nom) — plasma. A state of matter consisting of partially ionized gas and electrons.
- decrease /dɪˈkɹiːs/ (verbe) — diminuer. Of a quantity, to become smaller.
- rank /ˈɹæŋk/ (nom) — rangée. A row of people or things organized in a grid pattern, often soldiers.
- calcium /ˈkælsi.əm/ (nom) — calcium. 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/ (verbe) — stimuler. To encourage into action.
- kidney /ˈkɪdni/ (nom) — rein. An organ in the body that filters the blood, producing urine.
- regulate /ˈɹɛɡ.jə.leɪt/ (verbe) — régler. To dictate policy.
- urine /ˈjʊɹɪn/ (nom) — urine. 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/ (adjectif) — inhabituel, hors norme. Not conforming to rule or system; deviating from the usual or normal type.
- suffer /ˈsʌfɚ/ (verbe) — souffrir. To undergo hardship.
- genetic /d͡ʒəˈnɛt.ɪk/ (adjectif) — génétique. Relating to genetics or genes.
- infection /ɪnˈfɛkʃən/ (nom) — infection. The act or process of infecting.
- component /kəmˈpoʊ.nənt/ (nom) — composant. A smaller, self-contained part of a larger entity. Often refers to a manufactured object that is part of a larger device.
Les verbes à particule que vous entendrez
- look at (verbe) — regarder. To observe or watch.
- break down (verbe) — tomber en panne. To stop functioning.
- rule out (verbe) — barrer, biffer. To cross an item out by drawing a straight line through it, as with a ruler.
Prononciation à surveiller
- Les sons « th »: chemotherapy /ˌkiːməʊˈθɛɹəpi/, pathogenesis /ˌpæθ.ə(ʊ)ˈd͡ʒɛn.ə.sɪs/, erythropoietin /ɪˌɹɪθɹəˈpɔɪ.ɪtɪn/
- Les sons « sh » et « zh »: infection /ɪnˈfɛkʃən/, interaction /ˌɪn.təˈɹæk.ʃən/, activation /ˌæktəˈveɪʃən/, essentially /ɪˈsɛnʃəli/, associate /əˈsoʊʃi.ət/
- Mots longs — placez bien l’accent: interaction /ˌɪn.təˈɹæk.ʃən/, activation /ˌæktəˈveɪʃən/, chemotherapy /ˌkiːməʊˈθɛɹəpi/, essentially /ɪˈsɛnʃəli/, associate /əˈsoʊʃi.ət/
Comment s’entraîner avec cette vidéo
- Écoutez la vidéo en entier une fois sans parler et notez les mots que vous ne connaissez pas.
- Répétez phrase par phrase à vitesse normale, en reprenant chacune jusqu’à ce que votre rythme corresponde à celui du locuteur.
- Enregistrez-vous et comparez avec l’original, en faisant attention à des mots comme bone, marrow, plasma.
La grammaire de cette vidéo
Les structures que le locuteur utilise le plus, avec les mots exacts de la vidéo :
| Structure | Dans la vidéo |
|---|---|
| Voix passive be + participe passé — l’accent est mis sur ce qui arrive, pas sur qui le fait | are abnormally produced · being produced · are found |
| Propositions relatives who / which + proposition — une précision sur une personne ou une chose | Anemia, which will · osteoblast which will · proteins, which are |
Qu'est-ce que la technique du Shadowing ?
Le Shadowing est une technique d'apprentissage des langues fondée sur la science, développée à l'origine pour la formation des interprètes professionnels. Le principe est simple mais puissant : vous écoutez de l'anglais natif et le répétez immédiatement à voix haute — comme une ombre suivant le locuteur avec un décalage de 1 à 2 secondes. Les recherches montrent une amélioration significative de la précision de la prononciation, de l'intonation, du rythme, des liaisons, de la compréhension orale et de la fluidité.