Angiogenic interactions of vascular endothelial growth factor, of thymidine phosphorylase, and of p53 protein expression in locally advanced gastric cancer

The assessment of the angiogenic profile of tumors may become an important tool as a guide for the inclusion of novel drugs and molecular therapies into the standard chemoradiotherapy policy. Several studies have shown the prognostic importance of microvessel density (MVD) and of angiogenic factor expression in operable gastric cancer. In the present study we investigated, with immunohistochemistry the MVD, the expression of vascular endothelial growth factor (VEGF) and of thymidine phosphorylase (TP) expression, as well as the nuclear expression of p53 protein, in a series of patients with locally advanced inoperable gastric cancer. A strong association of VEGF with TP expression was noted (P = 0.005), and tumors coexpressing these factors had a statistically higher MVD (P = 0.0001). Nuclear p53 accumulation was also related to a high MVD (P = 0.004), and this was independent of VEGF or TP expression. Microvessel density showed a bell-shaped association with prognosis; cases with an intermediate MVD exhibit a favorable outcome (P < 0.05). A trend of nuclear TP expression to define a group of patients with poorer prognosis was noted (P = 0.06), while none of the remaining variables showed any significant association. The immunostaining results allowed the grouping of the angiogenic profile in four major categories: 1) highly vascularized tumors with VEGF and/or TP expression (about 36% of cases); 2) highly angiogenic tumors with p53 nuclear accumulation and low VEGF/TP expression (7% of cases); 3) poorly vascularized tumor with low VEGF/TP and negative nuclear p53 staining (32% of cases); 4) poorly vascularized tumors with TP expression (7% of cases). Specific therapies targeting hypoxia, VEGF, or TP expression as well as p53 gene therapy have entered clinical experimentation or are already available for clinical use. Using the suggested markers more than 80% of locally advanced gastric carcinomas can be grouped in different categories according to their angiogenic profile. Such a categorization may be useful for phase III trials on novel therapies targeting the major angiogenesis-related features studied here.     

Which are the most important discriminatory items for subclassifying non‐specific low back pain? A Delphi study among Greek health professionals

Rationale, aims and objectives Developing homogenous low back pain (LBP) classification groups is recommended for enhancing clinical outcomes. However, an important step towards the development of specific subgroups is the selection and consensus agreement among health professionals on the discriminatory clinical items (sings and symptoms) that should be included in the classification process. Thus, this study's objective was to develop a list of clinical features for the assessment of LBP by health care providers within Greece, which are believed to be discriminatory in identifying LBP subgroups. Methods A random sample stratified by geographical region and work status of 150 Greek physiotherapists (PTs) participated in a two‐round Delphi study. PTs were asked to obtain consensus and hierarchy, the most important items out of a list of evaluating/diagnostic features believed to be discriminatory for LBP patients. These items included 80 clinical features and were generated in by PTs and doctors previous work. Results Second‐round questionnaires were returned by 112 PTs (74.6% response rate). A total of 66 clinical features were rated as important discriminatory items in LBP assessment. Clinical items included characteristics of present symptoms and the history's condition, general medical history, information regarding patient function, patients' attitudes regarding movement, diagnosis, expectations, fear‐avoidance beliefs as well as aspects of a physical examination including observation, active and passive movements, neurological and muscular examination. Conclusions This is the first study identifying important clinical items for LBP patients in Greece. It may be that these features are ‘discriminatory’ for different LBP subsets; however, further research is needed.     

延续性护理在心脏瓣膜置换术患者中的应用效果分析

目的 探讨延续性护理在心脏瓣膜置换术患者中的应用效果.方法 选取2017年1月—2019年1月在四川省德阳市人民医院接受心脏瓣膜置换术治疗的80例瓣膜性心脏病患者作为研究对象,随机分为观察组和对照组各40例.出院后对照组不进行主动护理,观察组采用延续性护理,对两组患者干预前后服药依从性、生活质量及心功能进行比较分析.结果 出院时两组服药依从性、生活质量及心功能比较差异无统计学意义(P>0.05),出院后6个月观察组服药依从性、生活质量及心功能均优于对照组,差异有统计学意义(P<0.05).结论 延续性护理应用于心脏瓣膜置换术出院患者中可提高患者服药依从性,提升患者生活质量及心功能恢复,值得临床借鉴推广.     

Outcome of the treatment of invasive non-transitional cell carcinoma

BACKGROUND: We evaluated the treatment outcomes of non-transitional cell carcinoma (non-TCC) cases after radical cystectomy. METHODS: Radical cystectomy was performed in 259 invasive bladder cancer patients in our department and of these, 59 (22.7%) were non-TCC. Primary squamous cell carcinomas (SCC), adenocarcinomas and undifferentiated cancers (UC) were grouped as non-TCC of the bladder. Of the 59 non-TCC; 32 SCC, 20 UC, five adenocarcinoma and two sarcomatoid tumor cases were demonstrated. RESULTS: The 5-year disease-specific survival rate of TCC and non-TCC cases were 48.9 and 28.2%, respectively (P = 0.0016). The 5-year disease-specific survival rates of SCC and UC were 25.1 and 23.4%, respectively. The median survival time of SCC, UC and adenocarcinoma cases were 19, 12 and 6 months, respectively (P = 0.4579). The disease-specific survival rates of TCC and non-TCC cases at stage pT2NoMo were 79.1 and 27.2%, respectively (P = 0.0000). The median survival time of SCC, UC and adenocarcinoma cases were 19, 12 and 13.3 months, respectively, for the same stage. The survival time of TCC, SCC and UC cases at stage pT3NoMo were 23, 26 and 45 months, respectively (P = 0.2307). The median survival time at stages pT2-3N1Mo for the same groups were 18, 16 and 11 months, respectively (P = 0.0939). CONCLUSION: The study presented here demonstrates that both TCC and non-TCC cases have poor survival rates in locally advanced disease and that at the pT2NoMo stage the prognosis of non-TCC cases is poor when compared with TCC cases.     

Respiratory and laryngeal function during whispering

Established procedures for making chest wall kinematic observations (Hoit & Hixon, 1987) and pressure-flow observations (Smitheran & Hixon, 1981) were used to study respiratory and laryngeal function during whispering and speaking in 10 healthy young adults. Results indicate that whispering involves generally lower lung volumes, lower tracheal pressures, higher translaryngeal flows, lower laryngeal airway resistances, and fewer syllables per breath group when compared to speaking. The use of lower lung volumes during whispering than speaking may reflect a means of achieving different tracheal pressure targets. Reductions in the number of syllables produced per breath group may be an adjustment to the high rate of air expenditure accompanying whispering compared to speaking. Performance of the normal subjects studied in this investigation does not resemble that of individuals with speech and voice disorders characterized by low resistive loads.     

Gi-mediated muscarinic adenylyl cyclase inhibition in timolol-treated stunned porcine myocardium

The Gi-mediated muscarinic receptor-adenylyl cyclase system was examined in stunned myocardium induced by either three or five brief ischaemic periods after β-adrenoceptor blockade by timolol (0.1 mg kg^-1). The mid-left anterior descending coronary artery was occluded for 2, 10 and 2 min in four pigs, and for 2, 2, 5, 10 and 2 min in four other pigs. All the ischaemic periods were separated by 30 min of reperfusion and the biopsies were obtained 60 min after the last ischaemic period. Segment length function was measured in the ischaemic region and in the control region supplied by the left circumflex artery. In the two groups, the percentage systolic shortening was reduced equally, to 59±9 and 58±10% of control in the region subjected to ischaemia and only minimally in the control region. The biopsies from the stunned region from both groups showed: (1) no change in either the affinity for carbachol or the number of binding sites of the muscarinic receptors; (2) no alterations in messenger RNA encoding for the α subunit-2 of the inhibitory guanine nucleotide binding protein, as demonstrated by northern blot and solution hybridization; (3) no change in membrane-bound inhibitory guanine nucleotide binding protein, as shown by enzyme immunoassay utilizing a specific anti-peptide antibody, and (4) unchanged inhibition of stimulated adenylyl cyclase activity. These results suggest that there is an intact inhibitory guanine nucleotide binding protein-mediated muscarinic receptor adenylyl cyclase system in the stunned porcine myocardium.     

Influence of 5-Fluorouracil on Serum Lipids

The effect of the cytotoxic drug 5-fluorouracil (5-FU) on plasma lipid levels was studied in patients and animals. Seven patients with metastatic carcinoma of the colon and three with advanced breast cancer were treated with 5-FU monotherapy by i.v. push at a dose of 500 mg/m²/d for 3-5 consecutive days. The animal group comprised 9 rabbits treated with 5-FU by i.v. push at 12-18 mg/kg/d for 2 consecutive days. Measurements of serum lipid levels were performed before and 2 and 4 weeks after 5-FU administration. No obvious change of diet, body weight and bowel habits occurred during the study period. A significant reduction of total plasma cholesterol was observed in both patients and animals. The triglyceride levels were also reduced in the rabbits. Maximal cholesterol-lowering effect was observed in patients and rabbits with higher baseline cholesterol levels. The results suggest that 5-FU might interfere with lipid metabolism.