Nomogram-Based Prognostic Evaluation of Gastric Cancer Patients with Low Counts of Examined Lymph Nodes Outperforms the Predictive Ability of the 7th and 8th Editions of the American Joint Committee on Cancer Staging System

BACKGROUND

The American Joint Committee on Cancer (AJCC) staging system has limited accuracy in predicting survival of gastric cancer patients with inadequate counts of evaluated lymph nodes (LNs). We therefore aimed to develop a prognostic nomogram suitable for clinical applications in such cases.

METHODS

A total of 1511 noncardia gastric cancer patients treated between 1990 and 2010 in the academic surgical center were reviewed to compare the 7^th and 8^th editions of the AJCC staging system. A nomogram was developed for the prediction of 5-year survival in patients with less than 16 LNs evaluated (n = 546). External validation was performed using datasets derived from the Polish Gastric Cancer Study Group (n = 668) and the SEER database (n = 11,225).

RESULTS

The 8th edition of AJCC staging showed better overall discriminatory power compared to the previous version, but no improvement was found for patients with < 16 evaluated LNs. The developed nomogram had better concordance index (0.695) than the former (0.682) or latest (0.680) staging editions, including patients subject to neoadjuvant treatment, and calibration curves showed excellent agreement between the nomogram-predicted and actual survival. High discriminatory power was also demonstrated for both validation cohorts. Subsequently, the nomogram showed the best accuracy for the prediction of 5-year survival through the time-dependent ROC curve analysis in the training and validation cohorts.

CONCLUSIONS

A clinically relevant nomogram was built for the prediction of 5-year survival in patients with inadequate numbers of LNs evaluated in surgical specimens. The predictive accuracy of the nomogram was validated in two Western populations.

Retrospective determination of fallout radionuclides and 236U/238U, 233U/236U and 240Pu/239Pu atom ratios on air filters from Vienna and Salzburg, Austria

137Cs and 241Pu (via 241Am) concentrations were measured γ-spectrometrically on air filters from the early 1960s (mainly from 1964-66) from Vienna, Austria, and an alpine station in Salzburg, Austria. Accelerator mass spectrometry (AMS) was used to determine 240Pu/239Pu, 236U/238U and 233U/236U atom ratios as well as 236U, 239Pu and 240Pu atom concentrations. The maximum 236U/238U atom ratio of these unique undisturbed global fallout samples was (1.19 ± 0.31) × 10-5 in spring 1964. The 233U/236U atom ratios were found within (0.15-0.49) × 10-2 and indicate that the weapons tests of the early 1960s can be excluded as 233U source. The 236U/239Pu atom ratios were calculated in the range of 0.22-0.48.

Retrospective determination of U and Pu isotopes and atom ratios in lung samples from Vienna, Austria

Uranium and plutonium isotope concentrations as well as ²³⁶U/²³⁸U and ²⁴⁰Pu/²³⁹Pu atom ratios were measured by AMS in human lung samples from the early 1960s. The ²³⁶U concentrations as well as the ²³⁶U/²³⁸U atom ratios show a maximum in 1964, ²³⁹Pu and ²⁴⁰Pu concentrations are increasing continually from 1962 to 1965. ²³⁶U/²³⁸U atom ratios are lower by two orders of magnitude compared to corresponding aerosol data from Vienna, probably due to older ²³⁸U deposited in the lungs, enhanced ²³⁸U concentrations in the city air, and activity partition within different particle sizes. The ²³⁶U/²³⁹Pu atom ratios in lung samples are also lower than expected from the aerosol data, while ²⁴⁰Pu/²³⁹Pu atom ratios lie well within the range typical for nuclear bomb fallout.

European roe deer antlers as an environmental archive for fallout (236)U and (239)Pu

Anthropogenic (236)U and (239)Pu were measured in European roe deer antlers hunted between 1955 and 1977 which covers and extends beyond the period of intensive nuclear weapons testing (1954-1962). The antlers were hunting trophies, and hence the hunting area, the year of shooting and the approximate age of each animal is given. Uranium and plutonium are known to deposit in skeletal tissue. Since antler histology is similar to bone, both elements were expected in antlers. Furthermore, roe deer shed their antlers annually, and hence antlers may provide a time-resolved environmental archive for fallout radionuclides. The radiochemical procedure is based on a Pu separation step by anion exchange (Dowex 1 × 8) and a subsequent U purification by extraction chromatography using UTEVA(®). The samples were measured by Accelerator Mass Spectrometry at the VERA facility (University of Vienna). In addition to the (236)U and (239)Pu concentrations, the (240)Pu/(239)Pu isotopic ratios were determined with a mean value of 0.172 ± 0.023 which is in agreement with the ratio of global fallout (∼0.18). Rather high (236)U/(238)U ratios of the order of 10(-6) were observed. These measured ratios, where the (236)U arises only from global fallout, have implications for the use of the (236)U/(238)U ratio as a fingerprint for nuclear accidents or releases from nuclear facilities. Our investigations have shown the potential to use antlers as a temporally resolved archive for the uptake of actinides from the environment.

Settling the half-life of 60Fe: fundamental for a versatile astrophysical chronometer

In order to resolve a recent discrepancy in the half-life of 60Fe, we performed an independent measurement with a new method that determines the 60Fe content of a material relative to 55Fe (t1/2=2.744  yr) with accelerator mass spectrometry. Our result of (2.50±0.12)×10(6)  yr clearly favors the recently reported value (2.62±0.04)×10(6)  yr, and rules out the older result of (1.49±0.27)×10(6)  yr. The present weighted mean half-life value of (2.60±0.05)×10(6)  yr substantially improves the reliability as an important chronometer for astrophysical applications in the million-year time range. This includes its use as a sensitive probe for studying recent chemical evolution of our Galaxy, the formation of the early Solar System, nucleosynthesis processes in massive stars, and as an indicator of a recent nearby supernova.

Radioactivity in drinking water supplies in Western Australia

Radiochemical analysis was carried out on 52 drinking water samples taken from public outlets in the southwest of Western Australia. All samples were analysed for Ra-226, Ra-228 and Pb-210. Twenty five of the samples were also analysed for Po-210, and 23 were analysed for U-234 and U-238. Ra-228 was found in 45 samples and the activity ranged from <4.000 to 296.1 mBq L(-1). Ra-226 was detected in all 52 samples and the activity ranged from 3.200 to 151.1 mBq L(-1). Po-210 was detected in 24 samples and the activity ranged from 0.000 to 114.2 mBq L(-1). These data were used to compute the annual radiation dose that persons of different age groups and also for pregnant and lactating females would receive from drinking this water. The estimated doses ranged from 0.001 to 2.375 mSv y(-1) with a mean annual dose of 0.167 mSv y(-1). The main contributing radionuclides to the annual dose were Ra-228, Po-210 and Ra-226. Of the 52 drinking water samples tested, 94% complied with the current Australian Drinking Water Guidelines, while 10% complied with the World Health Organization's radiological guidelines which many other countries use. It is likely that these results provide an overestimate of the compliance, due to limitations, in the sampling technique and resource constraints on the analysis. Because of the increasing reliance of the Western Australian community on groundwater for domestic and agricultural purposes, it is likely that the radiological content of the drinking water will increase in the future. Therefore there is a need for further monitoring and analysis in order to identify problem areas.

236U/238U and 240Pu/239Pu isotopic ratios in small (2 L) sea and river water samples

Accelerator Mass Spectrometry (AMS) and alpha spectrometry were used to determine uranium ((236)U, (238)U, (234)U) and plutonium isotopes ((239)Pu, (240)Pu) in sea and river water samples. Plutonium was separated by Dowex(®) 1 × 8 resin and UTEVA(®) resin was used for uranium purification. The measured (236)U/(238)U isotopic ratios for surface water from the Atlantic Ocean, the Pacific Ocean and the Black Sea were in the order of 10(-9), while values for river water were in the order of 10(-8). These contaminations may be attributed to global fallout. A sample of the reference material IAEA-443, collected from the Irish Sea, showed, in accordance to the reference value, a ratio that was 10(3) times higher due to effluents from the reprocessing plant at Sellafield. These results underline the good suitability of (236)U/(238)U as a tracer for hydrology and oceanography, and show that relatively small water samples are sufficient for the determination of (236)U by AMS, which is not the case for plutonium with present techniques. The plutonium concentrations in our water samples could only be measured with large uncertainties and were in the order of 10(-3) mBq/L (with the exception of the Irish Sea sample).

AMS of the Minor Plutonium Isotopes

VERA, the Vienna Environmental Research Accelerator, is especially equipped for the measurement of actinides, and performs a growing number of measurements on environmental samples. While AMS is not the optimum method for each particular plutonium isotope, the possibility to measure ²³⁹Pu, ²⁴⁰Pu, ²⁴¹Pu, ²⁴²Pu and ²⁴⁴Pu on the same AMS sputter target is a great simplification. We have obtained a first result on the global fallout value of ²⁴⁴Pu/²³⁹Pu = (5.7 ± 1.0) × 10^-5 based on soil samples from Salzburg prefecture, Austria. Furthermore, we suggest using the ²⁴²Pu/²⁴⁰Pu ratio as an estimate of the initial ²⁴¹Pu/²³⁹Pu ratio, which allows dating of the time of irradiation based solely on Pu isotopes. We have checked the validity of this estimate using literature data, simulations, and environmental samples from soil from the Salzburg prefecture (Austria), from the shut down Garigliano Nuclear Power Plant (Sessa Aurunca, Italy) and from the Irish Sea near the Sellafield nuclear facility. The maximum deviation of the estimated dates from the expected ages is 6 years, while relative dating of material from the same source seems to be possible with a precision of less than 2 years. Additional information carried by the minor plutonium isotopes may allow further improvements of the precision of the method.

Anatomical classification of the shape and topography of the operated stomach

The aim of the study was to present the classification of anatomical variants of the operated stomach, based on radiological and historical data. Different anatomical variants of the operated organ were found in 431 out of 2034 patients examined in the years 2006-2010. Four main groups were established: abnormal position along longitudinal (I) and horizontal axis (II), as well as abnormal shape (III) and stomach connections (IV). An additional group (V) encloses mixed forms that combine features of two or more of the main groups. The first group contains the partial and total translocation of the stomach into the thoracic cavity after the partial or total oesophagectomy. Depending on the applied surgical techniques used during the total oesophagectomy, the stomach could be located anteriorly or posteriorly to the pericardial sac. An elongated and gastrectatic form often with signs of pylorostenosis is visible in patients treated by vagotomy. The consequences of fundoplication included: lack of or narrow cardiac angle, and often a mild form of stomach cascade. The most common abnormal shape of the stomach was secondary to gastrectomy and gastric bending. The final organ shape depends on the type of applied surgical procedure that maintains physiological connection with the duodenum or an un-anatomical one, mostly with the jejunal loop. In banding, the body of the stomach forms an hourglass at the level of the artificial adjustable band, typically applied in surgical treatment of obesity (slim surgery).

Depth profile of ²³⁶U/²³⁸U in soil samples in La Palma, Canary Islands

The vertical distribution of the (236)U/(238)U isotopic ratio was investigated in soil samples from three different locations on La Palma (one of the seven Canary Islands, Spain). Additionally the (240)Pu/(239)Pu atomic ratio, as it is a well establish tool for the source identification, was determined. The radiochemical procedure consisted of a U separation step by extraction chromatography using UTEVA Resin (Eichrom Technologies, Inc.). Afterwards Pu was separated from Th and Np by anion exchange using Dowex 1 x 2 (Dow Chemical Co.). Furthermore a new chemical procedure with tandem columns to separate Pu and U from the matrix was tested. For the determination of the uranium and plutonium isotopes by alpha spectrometry thin sources were prepared by microprecipitation techniques. Additionally these fractions separated from the soil samples were measured by Accelerator Mass Spectrometry (AMS) to get information on the isotopic ratios (236)U/(238)U, (240)Pu/(239)Pu and (236)U/(239)Pu, respectively. The (236)U concentrations [atoms/g] in each surface layer (∼2 cm) were surprisingly high compared to deeper layers where values around two orders of magnitude smaller were found. Since the isotopic ratio (240)Pu/(239)Pu indicated a global fallout signature we assume the same origin as the probable source for (236)U. Our measured (236)U/(239)Pu value of around 0.2 is within the expected range for this contamination source.

Investigation of the 236U/238U isotope abundance ratio in uranium ores and yellow cake samples

Uranium ores and yellow cake samples of known geographic origin were investigated for their n(236U)/n(238U) isotope abundance ratio. Samples from four different uranium mines in Australia, Brazil and Canada were selected. Uranium was separated by UTEVA® Resin and was measured by Accelerator Mass Spectrometry (AMS) at the Vienna Environmental Research Accelerator (VERA). The measurement of the isotope abundance ratio n(236U)/n(238U) will be used to investigate possible correlations between the original mineral (uranium ore) and the intermediate product (yellow cake). Such correlations are useful indicators for nuclear forensic or for non-proliferation purposes.

Determination of U, Pu and Am isotopes in Irish Sea sediment by a combination of AMS and radiometric methods

Samples from a marine sediment core from the Irish Sea (54.416 N, 3.563 W) were analyzed for the isotopic composition of uranium, plutonium and americium by a combination of radiometric methods and AMS. The radiochemical procedure consisted of a Pu separation step by anion exchange, subsequent U separation by extraction chromatography using UTEVA® and finally Am separation with TRU® Resin. Additionally to radiometric determination of these isotopes by alpha spectrometry, the separated samples were also used for the determination of (236)U/(238)U and plutonium isotope ratios by Accelerator Mass Spectrometry (AMS) at the VERA facility.

Small Angle Scattering from Nanocrystalline Pd

The microstructure of nanocrystalline Pd was investigated by small angle scattering of neutrons and X-rays. The samples were prepared by compacting small crystallites produced by evaporation and condensation in an inert gas atmosphere. The strong scattering signal is interpreted to arise from crystallites embedded in a matrix of incoherent interfaces. Size distributions were deduced from the scattering curves. They consist of two parts: the crystallite size distribution dictated by the production process, and a structureless contribution due to the correlation in the spatial arrangement of the crystallites. The crystallite size distribution may be described by a log-normal distribution centred at R=2nm. The characteristic form of the correlation contribution arises from the dense packing of non-spherical crystallites. From the scattering cross-section in absolute units the volume fraction vc of crystallites was obtained as vc≈0.3, and the mean atomic density ρi in the interfaces as ρi≈0.52. The change of structural parameters during thermal annealing of the samples was studied. Up to high temperatures an appreciable volume fraction of crystallites with nearly unchanged size remains along with large particles.

Near Surface Structure of Ion Implanted Si Studied by Grazing Incidence X-Ray Scattering

X-rays incident on a surface under grazing angle may undergo total external reflection and excite an interior wave field damped exponentially into the bulk. These evanescent waves are a sensitive probe for the study the real structure in the near surface region. We report results on the influence of implantation defects on Bragg diffracted and on diffuse intensities. By detailed comparison of Bragg intensities with predictions of dynamical scattering theory we detect the presence of amorphous layers and determine their thickness. For the first time defect induced diffuse scattering underconditions of grazing incidence andexit is observed and compared to recent theoretical results. Strength and symmetry of implantation induced defects can be determined as well as their depth distribution which is compared to results of a TRIM simulation: the defect distribution is found to agree with that of the deposited collisional energy.

Implications of overweight in gastric cancer: A multicenter study in a Western patient population

AIMS

The purpose of this study was to evaluate the effects of overweight on surgical and long-term outcomes in a Western population of patients with gastric cancer (GC).

METHODS

An electronic database of all patients with resectable GC treated between 1986 and 1998 at seven university surgical centres cooperating in the Polish Gastric Cancer Study Group was reviewed. Overweight was defined as a body mass index (BMI) of 25 kg/m(2) or higher.

RESULTS

Four hundred and ninety-two of 1992 (25%) patients were overweight. Postoperatively, higher BMI was associated with higher rates of cardiopulmonary complications (16% vs 12%, P = 0.001) and intra-abdominal abscess (6.9% vs 2.9%, P < 0.001). However, other complications and mortality rates were unaffected. The median disease-specific survival of overweight patients was significantly higher (36.7 months, 95% confidence interval (CI) 29.0-44.4) than those with BMI<25 kg/m(2) (25.7 months, 95%CI 23.2-28.1; P = 0.003). These differences were due to the lower frequencies of patients with T3 and T4 tumours, metastatic lymph nodes, distant metastases, and non-curative resections. A Cox proportional hazards model identified age, depth of infiltration, lymph node metastases, distant metastases, and residual tumour category as the independent prognostic factors.

CONCLUSIONS

Overweight is not the independent prognostic factor for long-term survival in a Western-type population of GC.

Distribution of 212Pb, 214Pb and 210Pb with its daughter products on aerosol fractions from Vienna and Badgastein (Austria)

Aerosols were collected with cascade impactor devices and the activity concentrations of 210Pb, 210Bi and 210Po were measured by liquid scintillation counting. In samples collected near to the laboratory also 212Pb and 214Pb could be determined. The activity concentrations, their particle size distributions and the calculated aerosol ages are discussed with regard to the prevailing weather conditions. Special emphasis is given to the fact, that excess 210Po occurs not only in urban, but also in rural environments and that it is mainly found on particles with very small diameters (0.15-0.30 µm).

Esomeprazole 20 mg vs. pantoprazole 20 mg for maintenance therapy of healed erosive oesophagitis: results from the EXPO study

BACKGROUND

Following initial healing of erosive oesophagitis, most patients require maintenance therapy to prevent relapse.

AIM

To compare endoscopic and symptomatic remission rates over 6 months' maintenance therapy with esomeprazole or pantoprazole (both 20 mg once daily) in patients with healed erosive oesophagitis.

METHODS

Patients with symptoms of gastro-oesophageal reflux disease and endoscopically confirmed erosive oesophagitis at baseline were randomized to receive esomeprazole 40 mg or pantoprazole 40 mg for up to 8 weeks. Patients with healed erosive oesophagitis and free of moderate/severe heartburn and acid regurgitation at 4 weeks or, if necessary, 8 weeks entered the 6-month maintenance therapy phase of the study.

RESULTS

A total of 2766 patients (63% men; mean age 50 years) received esomeprazole 20 mg (n = 1377) or pantoprazole 20 mg (n = 1389) and comprised the intention-to-treat population. Following 6 months of treatment, the proportion of patients in endoscopic and symptomatic remission was significantly greater for those receiving esomeprazole 20 mg (87.0%) than pantoprazole 20 mg (74.9%, log-rank test P < 0.0001). Esomeprazole 20 mg produced a higher proportion of patients free of moderate to severe gastro-oesophageal reflux disease symptoms and fewer discontinuations because of symptoms than pantoprazole 20 mg (92.2% vs. 88.5%, P < 0.001).

CONCLUSIONS

Esomeprazole 20 mg is more effective than pantoprazole 20 mg for maintenance therapy following initial healing of erosive oesophagitis and relief of gastro-oesophageal reflux disease symptoms.

Selected biochemical parameters and ultrastructural picture of pancreas due to Ulinastatin treatment of experimental acute pancreatitis

Urinary trypsin inhibitor (UTI, Ulinastatin) is a protease inhibitor that has not been yet used in Europe in any experimental trial of severe acute pancreatitis. We have combined the experimental model of severe, hemorrhagic form of acute pancreatitis, and pharmacological treatment with a protease inhibitor. Male Wistar rats were divided into four experimental groups: healthy controls, operated, operated with experimentally induced acute pancreatitis, and animals with acute pancreatitis--treated with UTI preparations. Subjects in the last group were administered UTI intraperitoneally 1 h after pancreatitis induction in an average standard dose of 3000 units/animal. Additionally, four subgroups were created in this treated group, based on the UTI administration time--number of standard doses received: 2 h - 1 standard dose, 6 h - 5 standard doses, 12 h - 11 doses, 24 and 48 h - 15 doses. Statistically significant differences in the serum amylase and lipase activity between the UTI-treated and non-treated subjects were found. In the group of non-treated animals, there a profound destruction of cellular organelles was observed with a total degradation of nuceli, endoplasmatic reticulum and zymogen granules. However, in the UTI-treated subjects, pathological processes proceeded with the significantly slower pace and in much smaller quantities.

A randomized comparative study of esomeprazole 40 mg versus pantoprazole 40 mg for healing erosive oesophagitis: the EXPO study

AIM

To assess the efficacy of the 8-week therapy with esomeprazole 40 mg vs. pantoprazole 40 mg for healing erosive oesophagitis (EE) as part of a management study.

METHODS

Patients had a history of gastro-oesophageal reflux disease symptoms (> or =6 months) and had suffered heartburn on at least 4 of the 7 days preceding enrollment. Endoscopies were performed to grade EE severity using the Los Angeles (LA) classification system at baseline, 4 and 8 weeks (if unhealed at 4 weeks). Heartburn severity was recorded by patients on diary cards. The primary end point was healing of EE by week 8 of treatment.

RESULTS

Of 3170 patients randomized, the intent-to-treat population consisted of 3151 patients (63% male, mean age: 50.6 years, 27% Helicobacter pylori-positive). Esomeprazole 40 mg healed a significantly greater proportion of EE patients than pantoprazole 40 mg at both 4 weeks (life table estimates: esomeprazole 81%, pantoprazole 75%, P < 0.001) and 8 weeks (life table estimates: esomeprazole 96%, pantoprazole 92%, P < 0.001). The median time to reach sustained heartburn resolution was 6 days in patients receiving esomeprazole and 8 days with pantoprazole (P < 0.001).

CONCLUSION

Esomeprazole 40 mg is more effective than pantoprazole 40 mg for healing EE and providing resolution of associated heartburn.

Restorative impact of rabeprazole on gastric mucus and mucin production impairment during naproxen administration: its potential clinical significance

Rabeprazole augments gastric mucus and mucin production in humans. However, its potential restorative impact on gastric mucus and mucin production impairment, resulting from administration of naproxen, remained to be explored. Therefore, we measured the content of mucus and mucin in gastric juice (GJ) before and after administration of naproxen with rabeprazole or placebo. The study was approved by HSC at KUMC and conducted in 21 asymptomatic, H. pylori-negative volunteers in a double-blind, placebo-controlled, crossover design. The content of gastric mucus in GJ, after exhaustive dialysis and complete lyophilization, was assessed gravimetrically, whereas the content of mucin was measured after its purification with equilibrium density-gradient ultracentrifugation in CsC1. Gastric mucus secretion during administration of naproxen with placebo declined significantly both in basal (by 44%; P < 0.001) and in pentagastrin-stimulated (by 35%; P < 0.001) conditions. Coadministration of rabeprazole significantly restored the naproxen-induced impairment in mucus production in basal conditions (by 47%; P < 0.01) and by 22% during stimulation with pentagastrin. Gastric mucin secretion during naproxen/placebo administration also declined significantly in both basal (by 39%; P < 0.01) and stimulated (by 49%; P = 0.003) conditions. Rabeprazole also significantly restored the naproxen-induced decline of gastric mucin output during pentagastrin-stimulated conditions (by 67%; P = 0.003) and by 40% in basal conditions (P = 0.05). The restorative capacity of rabeprazole on the quantitative impairment of gastric mucus and mucin during administration of naproxen may translate into a clinical benefit of protection of the upper alimentary tract from NSAID-related mucosal injury.

Assessment of prognostic significance of cytoplasmic survivin expression in advanced oesophageal cancer

Survivin is a member of the family of proteins, which inhibit apoptosis (inhibitor of apoptosis proteins - IAP). Expression of survivin was found in colorectal cancer, neuroblastoma, bladder cancer, non-small cell lung cancer, and breast cancer. There is some recent data indicating the correlation of poor prognosis and worse response to chemotherapy in patients with oesophageal squamous cell carcinoma (OSCC) expressing survivin. The aim of the present study was to assess survivin expression in cancerous tissue of patients with advanced OSCC and to test the potential correlation between survivin expression and clinicopathological data. Forty two patients (mean age 58.36+/-8.97 yrs), who were oesophagectomised due to squamous cell carcinoma of the thoracic oesophagus between 1998 and 2000, were retrospectively analysed. Cytoplasmic survivin expression, examined immunohistochemically, was found in 35 (83.33%) cases. No statistically significant correlation between survivin expression in the tumour and patients' gender, TNM stage, or vascular involvement was noted. The mean survival of patients with cytoplasmic survivin expression (17.81+/-5.51 months) was not statistically different to those with negative survivin staining (16+/-6.28 months) as assessed by Mantel-Cox test (p=0.49). Univariate regression analysis revealed UICC staging as the only predictor of survival in the analysed group (p<0.05). These results indicate that the cytoplasmic survivin expression does not seem to be the prognostic factor in advanced cases of OSCC.

Biochemical and immunohistochemical study on physiological activity and distribution of hepatic cathepsin D

Cathepsin D (EC 3.4.23.5) is a lysosomal endopeptidase physiologically present at very low concentration in different tissues. The aim of the study was to estimate the physiological activity and distribution of cathepsin D in the liver. Four groups of ten-week-old male Wistar rats were raised without xenobiotics and sacrificed on day 4, 42, 47 and 84 of the experiment, and their livers were taken for immunohistochemical and biochemical investigation. Immunostaining for cathepsin D was evaluated by light microscope. Activity of the free and bound fractions of hepatic cathepsin D was measured spectrophotometrically. Immunohistochemical staining for cathepsin D was positive in Browicz-Kupffer cells in some but not in all rat liver specimens of each experimental group. The staining pattern was cytoplasmic and granular. Occasionally the positive stained endothelial cells were also found. No activity of cathepsin D in hepatocytes was detected. The positive immunostaining was found in livers with high enzyme activity in the biochemical investigation. No significant differences in activity of the free and bound fractions of cathepsin D among the different age groups were noted. However, the higher, age-dependent activity (p>0.05) of the free fraction was observed in the youngest and the two-middle groups of rats that were sacrificed on day 42 and 47 than in the oldest one. The bound fraction did not reveal such changes. It could be concluded that there were no differences in the activity of hepatic free and bound fractions of cathepsin D in male Wistar rats of various reproductive age. The rat Browicz-Kupffer cells revealed the highest activity of cathepsin D.

Diethylnitrosamine may induce esophageal dysplasia after local intramural administration

PURPOSE

To assess the possibility of promoting esophageal squamous cell carcinoma after direct administration of diethylnitrosamine (DEN) into the wall of the esophagus.

MATERIAL AND METHODS

Adult male Wistar rats weighing 250-300 g were used in the studies. Via laparotomy, solution of DEN (at the volume of 0.1 ml) was injected directly into the esophageal wall. Animals were divided into 3 groups: CONTROL group--injected with saline, DEN1 group--injected with DEN 100 mg, DEN2 group--injected twice with DEN at the dose of 100 mg with 7 days interval (total dose of 200 mg).

RESULTS

Microscopic evaluation after 180 days revealed signs of esophagitis in 20% and 30% subjects in DEN1 and DEN2 group respectively. In 30% of animals from DEN1 and 50% animals from DEN2 group, low-grade dysplasia was recognized. The difference between DEN2 and control animals was statistically significant with p < 0.03. Neither high-grade dysplasia nor invasive carcinoma were found in both experimental groups. None of the liver specimens showed the evidence of pathology.

CONCLUSIONS

These initial results may indicate the possibility of development of premalignant lesions after local administration of carcinogen into esophageal wall. Observed changes were limited exclusively to esophagus which became the "target organ" in this model.

Circulating anti-p53 antibodies in esophageal cancer patients

Circulating anti-p53 protein antibodies (p53-Abs) have been detected in some cancer patients. The aim of the study was to determine the presence of circulating anti-p53 protein antibodies and their clinical significance in patients with esophageal carcinoma. Serum specimens from 75 consecutive patients with squamous cell carcinomas and 10 healthy subjects were studied. Enzyme linked immunosorbent assay (ELISA--Pharma Cell) was used to detect p53-Abs. At the time of diagnosis 20 (26.6%) of 75 analyzed patients had positive result in the p53-Abs test, but not any of the healthy subjects. The positive rate was 25% (1/4) cases in stage I, 41% (10/24) cases in stage IIA, 0% (0/8) cases in stage IIB, 28% (8/28) cases in stage III and 9% (1/11) cases in stage IV. In respect of tumour differentiation, cases graded as G1, G2 and G3 were positive in 28.5% (4/14), 25.9% (7/27) and 26.4% (9/34), respectively. There was no correlation between presence of p53-Abs and stage, rumour differentiation, lymph nodes metastases, tumour size, patient age and sex. In conclusion, the results of the present study indicate that serum p53-Abs did not correlate with cliniocopathologic feature of esophageal carcinoma.

Vascular endothelial growth factor and basic fibroblast growth factor in patients with squamous cell oesophageal cancer

It is suggested that vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) play an important role in tumor-induced angiogenesis. The purpose of this study was to estimate the correlation between VEGF and bFGF levels and tumor pathological status according to pTNM classification in patients with squamous cell oesophageal cancer. A group of 25 healthy controls and 32 consecutive patients with oesophageal cancer were included in this study. Serum VEGF and bFGF levels were determined by enzyme-linked immunosorbent assay (Quantikine R&D Systems). Serum VEGF and bFGF levels were significantly elevated in the patient groups (VEGF: 146.0 pg/ml, 79.0-386.3 pg/ml vs. 38.0 pg/ml, 6.5-135.1 pg/ml, p<0.005, and bFGF: 5.2 pg/ml, 1.2-10.6 pg/ml vs. 2.06 pg/ml, 0.07-4.0 pg/ml, p<0.02 Fisher test). The highest correlation between serum VEGF and bFGF levels were found in patients with advanced cancers, especially with: T4, N1, and M1 factors. The VEGF and bFGF levels were significantly higher in patients with pT4 (p<0.01). Patients with N1 lymph node invasion, compared with N0 factor, have higher levels of angiogenetic factors (p<0.04). Also in patients with advanced cancers with liver metastases the serum levels VEGF and bFGF were significantly higher (M1 vs. M0, VEGF p<0.001 and bFGF p<0.05). Consecutive monitoring of VEGF and bFGF serum levels may be a useful prognostic marker for patients with squamous cell oesophageal cancer.

Bleeding from gastro-intestinal tract caused by benign tumours of the small bowel

The paper discusses three cases of mass bleeding from the upper section of gastrointestinal tract caused by benign tumours od the small bowel. The technique of the intraoperative endoscopic examination of gastrointestinal tract has been described. The authors stress the usefulness of this technique in the case when the source of bleeding is difficult to localise.

p35 protein as a prognostic factor of squamous cell carcinoma of the oesophagus

Communications show that in squamous cell carcinoma of the oesophagus one can often observe overexpression of p53 protein. Wild type p53 protein suppresses cells' growth, and mutated p53 acts as onkogene. Gene p53 mutations usually lead to stabilization and accumulation of p53 protein, and, as a result they become detectable by immunochemical methods. Overexpression of p53 has been observed in 28 (46.7%) out of 60 collected specimens. It has no connection with sex, age, histological differentiation, category (pT) of tumour, infiltration (pN) of lymph nodes and extent of metastases (pMlym+). p53 protein expression has no correlation with survival predictability.

Visualisation of diverticula of the upper part of the alimentary tract; comparison of roentgenologic and endoscopic techniques

Diverticula of the upper part of the alimentary tract, irrespective of their etiology, are frequently observed benign changes of the pharynx, oesophagus, stomach and duodenum. In the present work, patients of the II General Surgery Department of the Medical University of Lublin, with radiologically or endoscopically proved diverticula of the upper part of the alimentary tract, were examined. The presence of diverticula of such localisation was an indication for supplementary endoscopic or radiological examination. The localisation, size, diameter of the opening, mucosal relief of diverticula and its contiguity were checked and analysed. Our data suggest that both medical procedures are complementary to each other. All previously observed changes in diverticula of the thoracic part of the oesophagus and the infradiaphragm part of the alimentary tract were fully proved. The radiological examination gave a better view of Zenker's diverticulum, especially in short and obese patients. Sampling and better visualisation of the diverticula opening testify to the unquestionable superiority of endoscopy. However, precise evaluation by radiological process fully completes the diagnostic protocol. Both diagnostic procedures are usually supplemented by manometric examination of the oesophagus and superior and inferior oesophageal sphincters. This enables the accurate diverticula etiology to be stated.

Range of serum bile acid concentrations in neonates, infants, older children, and in adults

BACKGROUND

Serum total bile acids (tBA) determination is a non-invasive, simple and very sensitive diagnostic test in evaluation of liver disorders. However, its usefulness is limited by lack of the data on normal value range of serum tBA concentrations in children, especially neonates and infants. The aim of the study was evaluation of serum tBA concentrations according to the age and gender of children, and their comparison with the values found in adults.

MATERIAL AND METHODS

Serum tBA concentration measurements were performed using enzymatic-colorimetric test Enzabile (Nycomed Pharma, N) in blood samples collected 3 hours after last meal in newborns and infants, and fasting in children over 1 year of age. The studied children were healthy, without any abnormalities on physical examination. In adults, the measurements were performed in fasting patients with inguinal hernia without any other concomitant diseases scheduled for elective surgery. Two hundred seventy eight children (145 females and 133 males) of ages ranging from the 1st day of life to 16 years, and 63 adults (39 males and 24 females) were investigated.

RESULTS

Serum tBA concentrations in newborns (mean (SD: 19.6 +/- 5.2 mumol/l) were significantly higher than the values found in adults (5.1 +/- 2.9 mumol/l). Serum tBA concentrations increased gradually after delivery, with peak values occurring at the age of 1 month (22.2 +/- 5.1 mumol/l), which then gradually declined to nearly adult levels. No gender-related differences were observed in serum tBA concentrations in children.

CONCLUSIONS

It is mandatory to refer to the age of the patient, interpreting values of serum tBA concentration in children.

Esophageal motility impairment--the cause or consequence of gastroesophageal reflux disease?

There are at least three, well-known, different groups of motor activity disturbances of the upper part of alimentary tract which can induce the development of gastroesophageal reflux disease (GERD) and enlarge the risk of excessive exposure of the esophageal mucous membrane on gastric juice and/or biliary contents. Most important is insufficiency of the lower esophageal sphincter (LES), which causes gastroesophageal reflux at 50-60% of patients suffering from GERD. Other reasons include impairment of stomach function (increase of intra-gastric pressure, late emptying and/or hypersecretion), and impairment of esophageal clearance. The question: does motility impairment of the esophagus occur primary or secondary to the gastroesophageal reflux, is still not enough clarified. Motor activity of the esophagus before and after the antireflux operation was prospectively assessed in 57 patients. Motility of the esophagus was determined by estimation: the efficacy of LES, general motor activity of the body of the esophagus and motor activity of the body during the reflux episodes, basing on 24-h manometry. Comparison of general pre- and postoperative data revealed significantly positive influence of Nissen-Rossetti fundoplication on improvement of motor activity of the esophagus, but the results differed in relation to the height of the measurements. Moreover comparison of the data during gastroesophageal reflux episodes revealed negative changes of the manometric parameters in the upper and middle esophagus. We conclude that post-operative improvement of esophageal motility confirms the secondary dysfunction in the peristalsis, connected with pathological reflux. However, lack of the complete normalization in motor activity after operation suggests that disorder may partially occur as primary impairment of motor activity or as the secondary dysfunction, which is fixed in the course of GERD.

Proliferating nuclear antigen (PCNA) as a prognostic factor of squamous cell carcinoma of the oesophagus

Proliferating nuclear antigen (PCNA) plays an important role both in the process of replication and repair of DNA. The aim of the carried out investigations was to find out if there was any correlation between the depth of malignant infiltration, invasion of lymph nodes, presence of metastases in extra-regional lymph nodes, the length of patients' survival, and the value of PCNA proliferating index analysed in biopsy specimens before the operation, taken from 60 patients with oesophageal squamous cell carcinoma. In the groups with advanced squamous cell carcinoma of the oesophagus the following statistic correlation was found between PCNA proliferating index and: invasion of lymph nodes--p < 0.04; degree of carcinoma progression--p < 0.01; and blood vessels infiltration--p < 0.001. The survival of patients with carcinomas of high (> 50%) and low (< 50%) PCNA index did not differ significantly. It results from the above investigations that high values of PCNA index may indicate the presence of metastases in lymphatic nodes and the degree of progression of oesophageal carcinoma.

Reinvestigation of airborne 210Pb, 137Cs and 207Bi in Vienna (Austria) after atmospheric nuclear weapons tests

Reconstruction of atmospheric 210Pb and 137Cs activity concentrations occurring in Vienna immediately after the atmospheric nuclear weapons tests shall answer the question, whether artificial 210Pb has been produced by fusion devices using lead materials. If so, 207Bi also can be expected. In 1962, weekly average values for 210Pb were between 0.08 +/- 0.02 and 1.31 +/- 0.30 mBq/m2, 137Cs amounts up to 5.1 +/- 0.6 mBq/m3. 207Bi remains below the detection limit, viz. < 0.5 mBq/m3. Bimonthly averages for the periods 1962-1964 and 1974-1975 show 137Cs activity concentrations with typical springtime maxima occurring together with low 210Pb values and 207Bi < 0.02 mBq/m3. Annual averages of 210Pb are varying between 0.27 and 0.53 mBq/m3, independent of whether atmospheric tests have been performed or not. Comparison of the activity ratios 207Bi/210Pb, 207Bi/137Cs and 210Pb/137Cs with published data, leads to the conclusion that no evidence exists for a significant production of 210Pb by nuclear explosions, neither after the Soviet tests in 1961-1962 nor after the Chinese tests in 1973-1976.

Interleukin-2 gene-modified allogeneic melanoma cell vaccines can induce cross-protection against syngeneic tumors in mice

Vaccination using well-characterized allogeneic tumor cell lines expressing standardized doses of immunostimulatory cytokines is an attractive alternative for autologous gene-transfected tumor cell vaccines. In the present study, we show that vaccination with irradiated allogeneic K1 735 (H-2k) or B16F10 (H-2b) melanoma cells induces a moderate degree of cross-protection against the M-3 melanoma (H-2d) in DBA/2 mice. Cross-protection against the syngeneic tumor was markedly improved when the allogeneic vaccines were transfected with the interleukin-2 (IL-2) gene. The IL-2 gene-modified allogeneic vaccines were effective for prophylactic vaccination against subsequent tumor challenge and for therapeutic vaccination against pre-existing tumor deposits, with efficacies that were comparable with that of the IL-2 gene-modified syngeneic vaccines. Cross-protection correlated with the cytotoxic activity of splenocytes against M-3 targets. Allogeneic vaccination was not effective in another model, against the B16F10 melanoma in C57BL/6 mice, irrespective of genetic modification with the IL-2 or granulocyte-macrophage colony-stimulating factor genes.

Angiogenesis inhibitors. New anticancer strategy

Neoangiogenesis has been proved to be crucial in neoplasmatic tumor growth and metastases. Over the last few years, the factors that have both a positive (angiogenic) and negative (antiangiogenic) influence on tumor growth have been identified. The potential use of natural and synthetic factors that suppress vasculature formation as anticancer drugs is currently under intense investigation. Recently, several antiangiogenic compounds, including TNP-470 or matrix metalloproteinase inhibitors, have entered clinical trials. This review will describe the main groups of angiogenesis inhibitors, their mechanisms of action and some data from clinical studies.

Phylogeny and in situ identification of a morphologically conspicuous bacterium, Candidatus Magnospira bakii, present at very low frequency in activated sludge

A morphologically conspicuous bacterium that constituted a very small fraction (< 0.01%) of the total microbial community of activated sludge was enriched and analysed phylogenetically by a combination of cultivation-independent molecular and physical methods. The large, corkscrew-shaped, filamentous bacteria were first detected in municipal activated sludge by light microscopy owing to their unusual rotating gliding motility. Various attempts at microbiological enrichment and pure culture isolation with traditional techniques failed, as did attempts to retrieve the morphotype of interest by micromanipulation. In situ hybridization with the group-specific, rRNA-targeted oligonucleotide probe CF319a indicated a phylogenetic affiliation to the Cytophaga-Flexibacter group of the Cytophaga-Flavobacterium-Bacteroides phylum. Based on strong morphological resemblance to members of the genus Saprospira, additional 16S rRNA-targeted oligonucleotides with more narrow specificity were designed and evaluated for in situ hybridization to the morphotype of interest. Flow cytometric cell sorting based on the fluorescence conferred by probe SGR1425 and forward scatter enabled a physical enrichment of the helical coiled cells. Subsequent polymerase chain reaction (PCR) amplification of 16S rDNA fragments from whole fixed sorted cells with a primer pair based on probes CF319a and SGR1425 resulted in the retrieval of 12 almost identical partial 16S rDNA fragments with sequence similarities among each other of more than 99.2%. In situ hybridizations proved that the sequences that showed the highest similarity (88.4%) to the 16S rRNA of Saprospira grandis were indeed retrieved from the corkscrew-shaped filaments. The bacterium is likely to be a member of a genus of which no species has been cultured hitherto. It was consequently tentatively named 'Magnospira bakii' and has the taxonomic rank of Candidatus Magnospira bakii, as the ultimate taxonomic placement has to await its cultivation. In this study, it was demonstrated that even bacteria occurring at very low frequencies in highly complex environmental samples can be retrieved selectively without cultivation for further molecular analysis.

Evaluation of the ChemScan system for rapid microbiological analysis of pharmaceutical water

The ChemScan system is a new method for the rapid detection and enumeration of viable microbial cells. It is based on the fluorescent labeling of viable microorganisms collected on a filter membrane and their subsequent automated detection and enumeration by a laser-scanning instrument. The new method was evaluated for the testing of pharmaceutical water by comparison with the standard plate count method. The ChemScan system appeared to be at least as sensitive as the standard method. In some cases the results were equivalent for both methods, but for most water samples the ChemScan results were higher than the standard plate count and sometimes exceeded the latter by an order of magnitude or more.

Flow cytometric analysis of the in situ accessibility of Escherichia coli 16S rRNA for fluorescently labeled oligonucleotide probes

In situ identification of whole fixed bacterial cells by hybridization with fluorescently labeled, rRNA-targeted oligonucleotide probes is often limited by low signal intensities. In addition to an impermeability of the cell periphery and a low cellular rRNA content, the three-dimensional structure of the ribosome may hinder the access of oligonucleotides to their target sites. Until now, a systematic study on the accessibility of 16S rRNA target sites had not been done. Here, we report fluorescence intensities obtained with more than 200 oligonucleotide probes (mostly 18-mers) used with whole fixed cells of Escherichia coli DSM 30083(T). Two overlapping sets of adjacent oligonucleotides, 171 in total, were designed to cover the full length of the 16S rRNA. The two sets are shifted by 5 to 13 nucleotides. The probes were labeled with carboxyfluorescein, and signal intensities of hybridized cells were quantified by flow cytometry. Care was taken that the signal intensity of cells was dependent solely on the in situ accessibility of probe target sites. The brightest signal resulted from probe Eco1482, complementary to positions 1482 to 1499. With this probe, the fluorescence was 1.7 times brighter than that of the standard bacterial probe EUB338 and 44 times brighter than that of the worst probe, Eco468. The distribution of probe-conferred cell fluorescence in six arbitrarily set brightness classes (classes I to VI; 100 to 81%, 80 to 61%, 60 to 41%, 40 to 21%, 20 to 6%, and 5 to 0% of the brightness with Eco1482, respectively) was as follows: I, 4%; II, 14%; III, 21%; IV, 29%, V, 19%; and VI, 13%. A more detailed analysis of helices 6, 18, and 23 with additional probes demonstrated that a shift of the target region by only a few bases could result in a decline of cell fluorescence from >80 to <10%. Considering the high evolutionary conservation of 16S rRNA, the in situ accessibility map of E. coli should facilitate a more rational selection of probe target sites for other species as well.

Sustained cytokine delivery for anticancer vaccination: liposomes as alternative for gene-transfected tumor cells

Vaccination with tumor cells genetically engineered to produce interleukin (IL)-2 is an attractive strategy to enhance antitumor immune responses. The improved antitumor immunity upon vaccination with IL-2 gene-modified tumor cells may be due to the prolonged presence of the cytokine at the vaccination site. Because liposomes have been used for sustained delivery of a variety of agents, we compared the protective effect of vaccines consisting of IL-2 gene-modified B16 melanoma cells to that of vaccines composed of IL-2 liposomes and irradiated melanoma cells. The results indicate that both approaches equally protect against a lethal challenge with B16 melanoma cells. More than 20% of the protected animals developed vitiligo at the vaccination and/or tumor challenge site.