Adjuvante und palliative Chemotherapie des kolorektalen Karzinoms in Deutschland außerhalb kontrollierter Studien

BACKGROUND AND OBJECTIVE

Colorectal cancer is the second most common malignant tumour in Germany with an unfavorable prognosis especially in a locally advanced or metastasizing stage. Although adjuvant and palliative chemotherapy significantly improve 5-year survival, consensus recommendations have in the past been inadequately transformed into clinical practice. It was the aim of this study to analyse the implementation of existing guidelines in a cohort from a defined area of Germany.

PATIENTS AND METHODS

In a multicentre study done between January 2000 and January 2002, tumour stage, primary care, adjuvant or palliative chemotherapy and follow-up of 444 patients (216 males, 228 females) with newly diagnosed colorectal cancer were recorded.

RESULTS

301 patients had colonic and 143 patients rectal cancer. The median age at diagnosis was 65 11.3 years. 36 of 96 (38%) patients with stage II colon cancer and 66 of 87 (76%) with stage III disease received adjuvant chemotherapy. 8 of 51 (16%) patients with rectal cancer stage II and 22 of 38 (58%) patients with stage III underwent adjuvant radio- and chemotherapy. The 68 of 84 (81%) patients with stage IV CRC who received palliative chemotherapy were given almost exclusively 5-FU monotherapy. Initial or sequential combination chemotherapy with oxaliplatin or irinotecan were performed in only 24 of 84 (29%) patients.

CONCLUSIONS

Stage III colon cancer was predominantly treated according to the existing standard guidelines. In contrast combined radio- and chemotherapy for rectal cancer stage II and III was only performed in one third of the patients, another third receiving neither adjuvant radiation nor chemotherapy. Initial combined or sequential combined chemotherapy for metastasizing colorectal cancer was rarely performed.

Tracking of Left Ventricular Long Axis From Real-Time Three-Dimensional Echocardiography Using Optical Flow Techniques

Two-dimensional echocardiography (2DE) is routinely used in clinical practice to measure left ventricular (LV) mass, dimensions, and function. The reliability of these measurements is highly dependent on the ability to obtain nonforeshortened long axis (LA) images of the left ventricle from transthoracic apical acoustic windows. Real time three-dimensional echocardiography (RT3DE) is a novel imaging technique that allows the acquisition of dynamic pyramidal data structures encompassing the entire ventricle and could potentially overcome the effects of LA foreshortening. Accordingly, the aim of this paper was to develop a nearly automated method based on optical flow techniques for the measurement of the left ventricular (LV) LA throughout the cardiac cycle from RT3DE data. The LV LA measurements obtained with the automated technique has been compared with LA measurements derived from manual selection of the LA from a volumetric display of RT3DE data. High correlation (r = .99, SEE = 1.8%, y = .94x + 5.3), no significant bias (-0.18 mm), and narrow limits of agreement (SD: 1.91 mm) were found. The comparison between the LA length derived from 2DE and RT3DE data showed significant underestimation of the 2DE based measurements. In conclusion, this study proves that RT3DE data overcome the effects of foreshortening and indicates that the method we propose allows fast and accurate quantification of LA length throughout the cardiac cycle.

Direct IR observation of vibrational properties of carbonyl species formed on Pd nano-particles supported on amorphous carbon: comparison with Pd/SiO2–Al2O3

By diluting optically opaque carbon-supported Pd particles in silica Aerosil we succeeded in observing the IR bands of adsorbed carbonyls and extracting information on the particle dispersion. Comparison with literature single crystal data and with silica-alumina supported Pd allowed us to make an assignment in terms of linear and 2-fold bridged carbonyls formed on Pd(111) and Pd(100) faces. Two Pd/C samples have been investigated. The relative intensities of the two carbonyl families observed on the two samples are consistent with the Pd dispersion independently measured with CO chemisorption, TEM and EXAFS analysis.

On the fraction of CrII sites involved in the C2H4 polymerization on the Cr/SiO2 Phillips catalyst: a quantification by FTIR spectroscopy

An estimation of the fraction of Cr(II) sites involved in the C(2)H(4) polymerization on a Cr(II)/SiO(2) Phillips catalyst has been obtained by means of in situ alternated CO adsorption and C(2)H(4) polymerization FTIR experiments: about 28% of the total surface sites react fast with C(2)H(4), while a lower fraction, which depends upon the temperature reaction conditions, is more slowly involved, in agreement with XANES results.

Population-based registration of unselected colorectal cancer patients: five-year survival in the region of Bonn/Rhine-Sieg, Germany

INTRODUCTION

Epidemiological data of colorectal cancer are sparse and often incomplete. Therefore, we initiated a population-based examination of five-year survival of colorectal cancer patients.

METHODS

For complete registration, diagnosis and tumour stage of all patients in the region of Bonn/Rhine-Sieg were assessed independently according to reports of medical practitioners and pathologists. Each patient was followed by a standardised questionnaire during a period of five years.

RESULTS

Between June and November, 1994 348 patients were registered. Median age at diagnosis was 69 years for males (n = 160) and 72 years for females (n = 188). According to the UICC classification 18, 26, 23 and 26 % had stage I-IV tumours, respectively; the tumour stage remained unclear in 7 %. Adjuvant (radio)-chemotherapy was indicated in 89 patients, but only 49 % of these were treated. Five-year overall survival (OS) and relative overall survival were 41 and 54 %, respectively. Although disease-free survival (DFS) was significantly better for early stage colorectal cancer, OS did not differ significantly between stage I and stage III tumours. Young patients diagnosed before the age of 50 had a significantly lower DFS. These data were comparable with other European countries but were lower than data reported in the USA.

DISCUSSION

The high rate of patients with stage IV colorectal cancer and the low proportion of patients receiving adjuvant (radio)-chemotherapy according to international or national consensus recommendations were disappointing. Although data were comparable with other European countries more efforts are necessary to establish effective screening programs for asymptomatic patients and to increase the willingness for standardised adjuvant treatment.

FTIR Investigation of the H2, N2, and C2H4 Molecular Complexes Formed on the Cr(II) Sites in the Phillips Catalyst: a Preliminary Step in the understanding of a Complex System

This work reports the first complete FTIR characterization of H2, N2 and C2H4 molecular complexes formed on the Cr(II) sites in the Phillips catalyst. The use of a silica aerogel as support for Cr(II) sites, substituting the conventional aerosil material, allowed us to obtain a remarkable increase in the signal-to-noise ratio of the IR spectra of adsorbed species. The improvement is directly related to an increase of the surface area of the support (approximately 700 m2 g(-1)) and to an almost complete absence of scattering [Groppo et al., Chem. Mater. 2005, 17, 2019-2027]. The use of this support and the adoption of suitable experimental conditions results, for the first time, in the clear observation of H2 and N2 adducts formed on two different types of Cr(II) sites, thus yielding important information on the coordinative state of the Cr(II) ions, which well agrees with the evidences provided in the past by other probe molecules. Furthermore, we report the first complete characterization of the C2H4 pi-complexes formed on Cr(II) sites. These results are particularly important in the view of the understanding of the polymerization mechanism, since the C2H4 coordination and the formation of pi-bonded complexes are the first steps of the reaction.

EXAFS and XANES Investigation of the ETS-10 Microporous Titanosilicate

In this work, we report state-of-the-art analysis of both Ti K-edge high-resolution XANES and EXAFS data collected on the ETS-10 molecular sieve at the GILDA BM8 beamline of the ESRF facility. The interatomic distances and the angles obtained in our EXAFS study are in fair agreement with the single-crystal XRD data of Wang and Jacobson (Chem. Commun. 1999, 973) and with the recent ab initio periodic study of Damin et al. (J. Phys. Chem. B 2004, 108, 1328) Differently from previous EXAFS work (J. Phys. Chem. 1996, 100, 449), our study supports a model of ETS-10 where the Ti atoms are bonded with two equivalent axial oxygen atoms. This model is also able to reproduce the edge and the post-edge region of the XANES spectrum. Conversely, the weak but well-defined pre-edge peak at 4971.3 eV can be explained only by assuming that a fraction of Ti atoms are in a local geometry similar to that of the pentacoordinated Ti sites in the ETS-4 structure. These Ti atoms in ETS-10 should be the terminal of the -Ti-O-Ti-O-Ti- chains, of which the actual number is strongly increased by the high crystal defectivity (Ti vacancies).

[Early diagnosis of colorectal tumors]

Colorectal cancer (CRC) is one of the most common causes of cancer mortality in Western countries. Approximately six percent of the population will develop colorectal cancer during life. Individuals older than 50 years or with a family history for colorectal tumors as well as patients with an inflammatory bowel disease have an increased risk for CRC. A significant reduction of colorectal cancer mortality can be achieved by screening of asymptomatic patients and removal of premalignant adenomatous polyp precursors. Colonoscopy is recognized as the gold standard, but in future virtual colonoscopy might be a reasonable addition. Asymptomatic individuals with an average risk for CRC should be screened from the age of 50 and then every 10 years if the examination showed no pathological findings. When the individual or family history indicate a higher risk for a colorectal neoplasia, screening should begin at the age of 40 or 10 years before the earliest tumor occurrence in the family. Families with hereditary CRC require a special surveillance.

Quantification of left ventricular modification in weightlessness conditions from the spatio-temporal analysis of 2D echocardiographic images

Two-dimensional echocardiography (2DE) performed during flights with a parabolic trajectory to simulate weightlessness provides a unique means to study left ventricular (LV) modifications to prevent post-flight orthostatic intolerance in astronauts. However, conventional analysis of 2DE is based on manual tracings and depends on experience. Accordingly, the aim was objectively to quantify, from 2DE images, the LV modifications related to different gravity levels, by applying a semi-automated level-set border detection technique. The algorithm validation was performed by the comparison of manual tracing results, obtained by two independent observers with 20 images, with the semi-automated measurements. To quantify LV modifications, three consecutive cardiac cycles were analysed for each gravity phase (1 Gz, 1.8 Gz, 0 Gz). The level-set procedure was applied frame-by-frame to detect the LV endocardial contours and obtain LV area against time curves, from which end-diastolic (EDA) and end-systolic (ESA) areas were computed and averaged to compensate for respiratory variations. Linear regression (y = 0.91x + 1.47, r = 0.99, SEE:0.80cm2) and Bland-Altman analysis (bias = -0.58 cm2, 95% limits of agreement= +/- 2.14cm2) showed excellent correlation between the semi-automatic and manually traced values. Inter-observer variability was 5.4%, and the inter-technique variability was 4.1%. Modifications in LV dimensions during the parabola were found: compared with 1 Gz values, EDA and ESA were significantly reduced at 1.8 Gz by 8.8 +/- 5.5% and 12.1 +/- 10.1%, respectively, whereas, during 0 Gz, EDA and ESA increased by 13.3 +/- 7.3% and 11.6 +/- 5.1%, respectively, owing to abrupt changes in venous return. The proposed method resulted in fast and reliable estimations of LV dimensions, whose changes caused by different gravity conditions were objectively quantified.

Electronic and vibrational properties of a MOF-5 metal–organic framework: ZnO quantum dot behaviour

UV-Vis DRS and photoluminescence (PL) spectroscopy, combined with excitation selective Raman spectroscopy, allow us to understand the main optical and vibrational properties of a metal-organic MOF-5 framework. A O(2-)Zn(2+)[rightward arrow] O(-)Zn(+) ligand to metal charge transfer transition (LMCT) at 350 nm, testifies that the Zn(4)O(13) cluster behaves as a ZnO quantum dot (QD). The organic part acts as a photon antenna able to efficiently transfer the energy to the inorganic ZnO-like QD part, where an intense emission at 525 nm occurs.