Production of secondary metabolites using tissue culture-based biotechnological applications

Plants are the sources of many bioactive secondary metabolites which are present in plant organs including leaves, stems, roots, and flowers. Although they provide advantages to the plants in many cases, they are not necessary for metabolisms related to growth, development, and reproduction. They are specific to plant species and are precursor substances, which can be modified for generations of various compounds in different plant species. Secondary metabolites are used in many industries, including dye, food processing and cosmetic industries, and in agricultural control as well as being used as pharmaceutical raw materials by humans. For this reason, the demand is high; therefore, they are needed to be obtained in large volumes and the large productions can be achieved using biotechnological methods in addition to production, being done with classical methods. For this, plant biotechnology can be put in action through using different methods. The most important of these methods include tissue culture and gene transfer. The genetically modified plants are agriculturally more productive and are commercially more effective and are valuable tools for industrial and medical purposes as well as being the sources of many secondary metabolites of therapeutic importance. With plant tissue culture applications, which are also the first step in obtaining transgenic plants with having desirable characteristics, it is possible to produce specific secondary metabolites in large-scale through using whole plants or using specific tissues of these plants in laboratory conditions. Currently, many studies are going on this subject, and some of them receiving attention are found to be taken place in plant biotechnology and having promising applications. In this work, particularly benefits of secondary metabolites, and their productions through tissue culture-based biotechnological applications are discussed using literature with presence of current studies.

Lemna minor, a hyperaccumulator shows elevated levels of Cd accumulation and genomic template stability in binary application of Cd and Ni: a physiological and genetic approach

In this study, to determine whether having potential to be used as hyperaccumulator for Cd and Ni, numerous experiments were designed for conducting assessments for physiological and genotoxic changes along with defining possible alterations on mineral nutrient status of Lemna minor L. by applying Cd-Ni binary treatments (0, 100, 200 and 400 µM). Our study revealed that there were increases in the concentrations of B, Cr, Fe, K, Mg, and Mn whereas decreases were noticed in the concentrations of Na and Zn and the levels of Ca were inversely proportional to Cd-Ni applications showing tendency to increase at the low concentration and to decrease at the high concentration. Randomly Amplified Polymorphic DNA (RAPD) and Inter Simple Sequence Repeat (ISSR) analyses revealed that rather than band losses and new band formations, mostly intensity changes in the band profiles, and low polymorphism and high genomic template stability (GTS) were observed. Although, to date, L. minor was defined as an efficient hyperaccumulator/potential accumulator or competent phytoremedial agent by researchers. Our research revealed that L. minor showing high accumulation capability for Cd and having low polymorphism rate and high genomic template stability is a versatile hyperaccumulator, especially for Cd; therefore, highly recommended by us for decontamination of water polluted with Cd. NOVELTY STATEMENTMany studies have been focused on the effects of individual metal ions. However, heavy metal contaminants usually exist as their mixtures in natural aquatic environments. Especially, Cd and Ni coexist in industrial wastes.In this study, the accumulation properties of Lemna minor for both Cd and Ni were investigated and the effects of Cd and Ni on the bioaccumulation of B, Ca, Cu, Fe, Mg, K, Mn, Na, Pb and Zn in L. minor were also determined. This study furthermore aimed to assess the genotoxic effects of Cd and Ni found in being extended concentrations on DNA using the Randomly Amplified Polymorphic DNA-Polymerase Chain Reaction (RAPD-PCR) method.

Alterations in the immunoreactivity of laminin, type IV collagen and α3β1 integrin in diabetic rat ovarian follicles

AIM

In order to determine the possible effects of diabetes, we aimed to investigate the expression of extracellular matrix proteins in the theca and granulosa layers in different follicular stages.

METHODS

Thirty-two adult Wistar albino male rats were divided into 4 groups as control and sampled groups. Four, eight and twelve weeks after inducing diabetes with an intraperitoneal injection of streptozotocin (40 mg/kg), the expressions of laminin, type IV collagen and α3β1 integrin in ovarian tissues were evaluated by immunohistochemical method.

RESULTS

In our study, in the first month of diabetes, a significant increase was observed in laminin, type IV collagen and α3β1 integrin expressions in all follicle types compared to the control group in both the theca and granulosa layers. Laminin and type IV collagen immunoreactivity tended to increase in D2 and D3 groups also. Integrin expression did not change in the newly formed follicles in the D2 and D3 groups, however, it tended to change and increase in the developing follicles.

CONCLUSIONS

The changes in the expression of laminin, type IV collagen and α3β1 integrin, which are the extracellular matrix proteins in the follicle, along with diabetes, show that diabetes plays a role in the regulation of follicular development (Tab. 4, Fig. 36, Ref. 29).

The investigation of the antitumoral effect of Cornus mas L in mice with ehrlich solid tumor

AIM

Cornus mas L is commonly used due to its anti-inflammatory, anti-carcinogenic and anti-oxidant properties. In the study, the effects of C. mas L extract on a solid tumor were examined in the Ehrlich solid tumor model developed in Balb/C type mice.

METHODS

Ehrlich acid tumor (EAT) cells (1x106 EAT cell) from the stock animal were injected subcutaneously (s.c.) through the nape of the mice. Treatment groups of solid tumor-induced animals received 100 mg/kg and 200 mg/kg of C. mas L extract intraperitoneally (i.p.) for 14 days.

RESULTS

Tumor volumes and animal weights were found to be statistically significant compared to the control group (p < 0.05). AgNOR staining was performed in tumor tissues. Statistically significant differences were observed between the groups in terms of TAA/NA ratio (p < 0.05). Immunohistochemical and biochemical parameters were also evaluated. An estimation of tumor proliferation of the lung, liver, brain, kidney, testis and tumor antioxidant parameters viz. lipid peroxidation, reduced glutathione (GSH), glutathione S-transferase (GST), superoxide dismutase (SOD) and catalase (CAT) was made.

CONCLUSIONS

Our study showed that the anti-tumor effect of C. mas L in assisted tumor development with EAT cells, was mediated by the enhancement of oxidative stress with multiple mechanisms (Tab. 6, Fig. 12, Ref. 38).

The Effect of Venous Thromboembolism on Survival of Cancer Patients and its Relationship with Serum Levels of Factor VIII and Vascular Endothelial Growth Factor: A Prospective Matched-Paired Study

Background

Venous thromboembolism (VT) increases mortality and morbidity in cancer patients. The primary aim of this study was to evaluate the effect of VT on the survival of cancer patients and its relationship with serum vascular endothelial growth factor (VEGF) and plasma factor VIII levels.

Patients and methods

Eighty-two patients with locally advanced or metastatic cancer were included in this study between September 2001 and March 2004, and 31 of them had VT. Fifty-one matched-paired cancer patients without VT were prospectively selected as a control group in the same period. Criteria for the selection of control group patients were having the same malignancy, stage, metastatic site, performance status and age (±5 years) as patients in the VT group.

Results

Plasma factor VIII and serum D-dimer levels in the VT group were significantly higher than those in the control group (p=0.030 and p=0.016, respectively). However, mean serum VEGF levels were similar in both groups (p=0.199). In the VT group, the median survival of patients who had higher serum VEGF levels (>150 pg/mL) was significantly shorter than that of patients in the same group with lower serum VEGF levels (p=0.005). The median survival of the VT group was 14 months, whereas it was 25 months in the control group (p=0.199).

Conclusion

There was a worse prognostic trend for cancer patients with VT. Nevertheless, the difference in survival was not statistically significant between the groups. Plasma factor VIII and serum D-dimer levels might have prognostic value in cancer patients with VT. Cancer patients with VT and higher serum VEGF levels had a significantly poorer prognosis.

Behavioural characterization of AnkyrinG deficient mice, a model for ANK3 related disorders

ANK3 encodes AnkyrinG (AnkG), a member of the Ankyrin family that is expressed in several different isoforms in many tissues. A unique serine-rich domain and tail domain in the two largest isoforms of AnkG (270 and 480kDa), restrict AnkG to the axon initial segment and nodes of Ranvier of myelinated neurons. At these sites, AnkG is a master regulator, coordinating the strict clustering of components necessary for proper action potential initiation and propagation along the axon. These components include voltage-gated sodium channels, potassium channels and members of the L1 cell adhesion molecule family. Genetic variation in the ANK3 gene has been linked to a range of neuropsychiatric and neurodevelopmental disorders in human, including schizophrenia, bipolar disorder, intellectual disability and autism spectrum disorders. Here, we study the effect of reduced expression of the large isoforms of Ank3 on cognition and behaviour using a heterozygous knockout mouse model. In three independent behavioural tests, being the open field test, elevated plus maze and social interaction test, we found evidence for increased anxiety in our Ank3 mouse model. Besides, we observed specific neuroanatomical defects in heterozygous knockout mice, including a smaller cingulate cortex, granular retrosplenial cortex, primary motor cortex and fimbria of the hippocampus.

The efficacy of tissue factor -603A/G and +5466A>G polimorphisms at the development of venous thromboembolism in cancer patients

Venous thromboembolism (VTE) is one of the most common complications in cancer patients. Although factor V Leiden (FVL) is the most common genetic defect causing thrombosis, the impact of gene abnormalities on thrombotic tendency in cancer patients remains poorly explored. Tissue factor (TF) is a major physiologic initiator of blood coagulation. This is the first study regarding the association of TF gene -603A/G and +5466A>G polymorphisms with VTE in malignancy. Materials and Me-thods: The study consists of two groups: cancer patients with VTE were included as Group 1 (n = 46); Group 2 comprises 196 cancer patients without VTE. Restriction fragment length polymorphism method was used for the detection of polymorphisms of TF -603A/G in the 5՛upstream region and TF 5466A/G in intron 2. FVL, PT G20210A and MTHFR C677T polymorphisms were determined by using commercially available Light Cycler kits. The genotype and allele frequencies between the groups were compared using χ2 or Fisher exact test, if appropriate.

RESULTS

No differences were observed in the distribution of TF gene -603A/G genotype frequencies between the groups. Although a slightly increased incidence of +5466GA genotype was in Group 1 (17.4% vs 11.2%), it did not achieve statistical significance. The prevalence of FVL was significantly greater in Group 1 compared with Group 2 (41.3% vs 4.1%, p < 0.05). Difference in frequency of 677TT+CT (MTHFR) + 5466GG (TF) genotypes combination was found in women of two investigated Groups (p < 0.05). No differences were also in genotypes and allele frequencies of MTHFR C677T and PT G20210A between two Groups (p > 0.05).

CONCLUSIONS

The present study did not show significant association of TF gene -603A/G and +5466A>G polymorphisms with VTE in malignancy, however, further larger studies including different ethnic population are needed to confirm our findings.

Occult urinary incontinence in elderly women and its association with geriatric condition

OBJECTIVE

Many older women are hesitated to initiate discussions about urinary symptoms and their incontinence. The aim of this study is to determine the prevalence of occult urinary incontinence in outpatient older women and to evaluate its association with other geriatric conditions.

PATIENTS AND METHODS

100 female patients 65 years and older were assessed at the geriatric outpatient clinic. The validated form of the Turkish version of the International Consultation on Incontinence Questionnaire-Short Form was used to evaluate urinary incontinence and quality of life. Comprehensive geriatric assessment including activities of daily living, instrumental activities of daily living, mini mental state examination and geriatrics depression scale was performed. The number of falls, comorbid conditions and number of medications were noted. The association between urinary incontinence and geriatric domains were evaluated with logistic regression analysis.

RESULTS

A total of 100 patients were evaluated, 64 of them included in the study. The median age of patients was 72.5. The rate of urinary incontinence was found 40.6%. The association between urinary incontinence and quality of life, performance status and comorbidity was found statistically significant with logistic regression (p = 0.033, p = 0.005, p = 0.031 respectively). Half of the patients with UI believe that it is part of normal aging and no definite treatment is available.

CONCLUSIONS

Occult urinary incontinence is a significant problem in older women that inversely affecting the quality of life. The study suggests that awareness and education regarding incontinence should be increased among elderly patients and screening of urinary incontinence is an important part of the geriatric assessment. The evaluation and management of functional status and comorbid conditions should be the initial step during incontinence management in elderly patients.

The role of cardiac biomarkers as predictors of trastuzumab cardiotoxicity in patients with breast cancer

AIM

Identification of patient with increased risk of cardiotoxicity would allow not only prevention and early diagnosis of chemotherapy related cardiotoxicity but also administration of optimal dose and duration of chemotherapy.

MATERIALS AND METHODS

Fifty-two women with HER2(+) breast cancer treated with trastuzumab were included in this study. Patients were prospectively followed with routine cardiac evaluation. Before and after administration of trastuzumab blood samples for NT-proBNP were also taken.

RESULTS

The median age was 48.5 year (range: 26-74). Hypertension and obesity were two most common co-morbidities. The median duration application of trastuzumab was 52 weeks. During median 14.5 (3-33) months follow-up cardiac adverse events occurred in 5 (9.6%) patients and 2 out of 5 was grade III-IV heart failure. Both patients had preserved left ventricular ejection fraction and no symptom of heart failure before trastuzumab but older than 65 years old and had diabetes mellitus and obesity. High level of NT-proBNP (> 300 ng/ml) was observed in both patients and heart failure recovery was not observed. There was statistically significant difference regarding body mass index (p = 0.004) and diabetes mellitus (p = 0.002) between patients with and without cardiotoxicity.

CONCLUSION

Although, cardiac biomarkers still cannot replace routine cardiac monitoring, natriuretic peptides may provide additional tool for detection of patients with high risk of cardiotoxicity and early detection of cardiotoxicity.

Overview on locally advanced breast cancer: defining, epidemiology, and overview on neoadjuvant therapy

According to the analysis on locally advanced breast cancer (LABC) from all breast cancer cases recorded in Surveillance Epidemiology and End Results database between the years 1992-1999 in the United States, the incidence of LABC were found to be 4.6% of all female breast cancers. Clinically, when breast cancer has advanced locoregionally but has not yet spread outside of the breast and regional lymph nodes, it is considered LABC. LABC includes breast cancers that have evidence of a large mass, involve the skin of the breast or the underlying muscles of the chest wall, and cancers that have infiltrated into the local lymph nodes. The prognosis of patients with LABC is relatively poor, with 5-year survival rates less than 50%. Because the incidence of LABC is very low, there are not many studies comparing neoadjuvant chemotherapy regimens in the literature. In management of LABC, initial therapy should be systemic neoadjuvant chemotherapy, aiming pCR. Anthracycline-based chemotherapy regimens are frequently recommended as the standard primary neoadjuvant chemotherapy for the treatment of LABC. Today, the optimal duration of neoadjuvant chemotherapy is unknown. Neoadjuvant endocrine therapy is considered an option for patients with hormone receptor-positive LABC. Ongoing clinical trials are now under way to evaluate the use of novel targeted agents in the neoadjuvant treatment of LABC.

Staging, risk assessment and screening of breast cancer

Breast cancer is the most common female malignant disease in the western countries where a woman's lifetime risk of developing the disease is more than 10%. Nulliparity or use of hormonal replacement therapy, strong family history, or a history of therapeutic thoracic radiation are considerable high risk factors for the development of breast cancer. Nowadays more new effective therapeutic agents have been developed for the intervention of the breast cancer, but prognosis is still remained poor in the metastatic disease. For the general population, screening mammography in women older than 40-45 years has been shown to be effective in identifying early-stage breast cancer and in decreasing the mortality rate. In randomized screening mammography trials for breast cancer, it has been established that screening mammograms reduced breast cancer mortality in women older than 50 years of age by 25 to 30%. This review article summarizes the risk factors for developing breast cancer, methods for risk assessment and the accepted screening guidelines.

ABO and Rh blood groups frequency in women with HER2 positive breast cancer

PURPOSE

The role of genetic factors in the development of cancer is widely accepted. Data on the role of ABO blood group and Rh factor in breast cancer is inconclusive. The aim of this study was to investigate the presence of a possible association between HER2 (+) breast cancer in Turkish women and ABO blood groups and Rh factor.

METHODS

In 294 female patients with HER2 (+) breast cancer, ABO blood groups and Rh factor were examined. The relationship of blood groups with age, menopausal status, and family history of cancer, estrogen receptor (ER), progesterone receptor (PR) and HER2 status of these patients was evaluated. Blood groups distribution of 22,821 healthy blood donors was also assessed and compared with the patients' blood groups distribution.

RESULTS

The median patient age was 47 years (range 20-80) and 56% of the patients were premenopausal. ER and PR were positive in 50 and 60% of the patients, respectively. Overall, the ABO blood group distribution of the 294 HER2 (+) breast cancer patients was similar to that of the healthy blood donors (p=0.36). Likewise there was no correlation between blood type and ER, PR and menopausal status. Rh (-) patients had more frequent family cancer history and this difference was significant for patients with blood group B Rh (-) and O Rh (-) (p = 0.04).

CONCLUSION

In the present study we didn't find any relationship between HER2 status and ABO blood group and Rh factor. However, further studies with larger number of patients are needed to establish the role (if any) of blood groups in patients with breast cancer.

Malign peritoneal mesothelioma with nephrotic syndrome

Nephrotic syndrome may occur in malignancies like Hodgkin Disease and other solid tumors due to glomerulonephritis, amyloidosis or other causes. However, it is rare in peritoneal mesothelioma. We report a 42-year old female patient with peritoneal mesothelioma and nephrotic syndrome together with a review of literature (Tab. 1, Fig. 3, Ref. 7).

Primitive neuroectodermal tumors of the central nervous system associated with genetic and metabolic defects

AIM

To evaluate the genetic, congenital and metabolic disorders which were detected concurrently with primitive neuroectodermal tumors (PNET) of the central nervous system in children.

METHODS

Medical records of 1030 children who were admitted to our department with diagnosis of brain tumor between 1975 and 2005 were reviewed retrospectively. Medulloblastoma and supratentorial PNETs were detected in 289 patients. They were reviewed for associated metabolic conditions, genetic and congenital defects.

RESULTS

One of the following conditions were detected in 10 patients with medulloblastoma and supratentorial PNETs: Neurofibromatosis type 1, Gorlin syndrome, juvenile polyposis coli, cancer prone syndrome of total premature chromatid separation and Fanconi anemia, bilateral retinoblastoma, L-2-hydroxyglutaric aciduria, Gilbert syndrome, gray platelet syndrome, cleft lip-palate and left renal agenesis. In the patients with multiple malignant diseases, cancer prone syndrome of total premature chromatid separation and Fanconi anemia, Gorlin syndrome and juvenile polyposis coli were diagnosed after diagnosis of the malignant tumors. Medulloblastoma was the first manifestation in the case with Gorlin syndrome. In case with retinoblastoma, pineal PNET was detected 2 months after diagnosis of retinoblastoma. Cleft lip-palate and L-2-Hydroxyglutaric aciduria were detected previously in the patients before their brain tumors whereas Gray platelet, Gilbert syndrome and left renal agenesis were diagnosed during treatment of medulloblastoma.

CONCLUSION

Associated genetic, metabolic and congenital conditions were detected in 3.5% of the cases. Thus the patients with PNET should be followed for these defects.

Real-time measurement system for tracking birefringence, weight, thickness, and surface temperature during drying of solution cast coatings and films

This paper describes the design and performance of a new instrument to track temporal changes in physical parameters during the drying behavior of solutions, as well as curing of monomers. This real-time instrument follows in-plane and out-of-plane birefringence, weight, thickness, and surface temperature during the course of solidification of coatings and films through solvent evaporation and thermal or photocuring in a controlled atmosphere. It is specifically designed to simulate behavior of polymer solutions inside an industrial size, continuous roll-to-roll solution casting line and other coating operations where resins are subjected to ultraviolet (UV) curing from monomer precursors. Controlled processing parameters include air speed, temperature, initial cast thickness, and solute concentration, while measured parameters are thickness, weight, film temperature, in-plane and out-of-plane birefringence. In this paper, we illustrate the utility of this instrument with solution cast and dried poly (amide-imide)∕DMAc (Dimethylacetamide) solution, water based black paint, and organo-modified clay∕NMP (N-Methylpyrrolidone) solution. In addition, the physical changes that take place during UV photo polymerization of a monomer are tracked. This instrument is designed to be generic and it can be used for tracking any drying∕swelling∕solidification systems including paper, foodstuffs such as; grains, milk as well as pharmaceutical thin paste and slurries.

Kikuchi--Fujimoto disease: cervical lymphadenopathy suggestive of relapsing lymphoma in patient with lymphoblastic lymphoma

AIM

Kikuchi - Fujimoto disease (KFD) or histiocytic necrotizing lymphadenitis is a rare disorder and often confused with lymphoma.

PATIENT

There is presented a case of 28-year-old patient with cervical lymphadenopathy, who had history of lymphoma.

RESULTS

On immunohistopathologic examination diagnosis of KFD was made and patient followed without any treatment.

CONCLUSION

Patient's lymphadenopathy had almost resolved and he was completely asymptomatic after three months. In patient with cervical lymphadenopathy KFD should be considered in the differential diagnosis.

Concomitant temozolomide and radiotherapy versus radiotherapy alone for treatment of newly diagnosed glioblastoma multiforme

PURPOSE

To study the efficacy and safety of radiotherapy (RT) with concomitant and subsequent temozolomide in comparison to RT alone in the treatment of patients with newly diagnosed glioblastoma multiforme (GBM) after brain surgical intervention.

METHODS

Twenty patients received cranial fractionated RT (60 Gy total dose: 2 Gy/day, 5 days/week, for 6 weeks) with concomitant oral temozolomide (75 mg/m(2)/day x 7 days/ week, for 6 weeks) followed by temozolomide monotherapy (200 mg/m(2)/day × 5 days every 28 days for 6 cycles). Another 20 patients received only cranial RT (Co-60 teletherapy, 60 Gy in 30 fractions).

RESULTS

At the end of the study the median time to progression free survival (PFS) was 13 months in the temozolomide plus RT treatment group and 5 months in the RT-alone group (p=0.0001). Median overall survival (OS) in the temozolomide plus RT and the RT-alone group was 19 and 11.5 months, respectively (p=0.0264). The main side effect in the temozolomide plus RT group was myelosuppression. Concomitant treatment resulted in grade 3 hematologic toxicity in 6 patients.

CONCLUSION

These data show that the combination of temozolomide, concomitant and subsequent to RT seems more effective than RT alone in patients with newly diagnosed GBM and that multimodality treatment is safe and well tolerated.

Two cases with atypical metastasis in colorectal cancer: splenic and renal metastasis

Atypical metastasis, such as splenic and renal metastasis is rare in colorectal cancer. There have been case reports of colorectal cancer patients with isolated splenic metastasis, even after years of surgery in the literature.

AIM

To report two colorectal cancer cases with atypical metastasis.

RESULTS

The first patient was a 58-year old man who had isolated splenic metastasis after 20 months of surgery. The other one was a 51-year old male patient with both lung and renal metastasis at rectal cancer diagnosis. Splenic and renal metastases have been histopathologically documented in both of them. The first patient was given chemotherapy after splenectomy. The other one had also multiple lung metastases besides renal metastasis. He received palliative chemotherapy.

Education, economic status and other risk factors in gastric cancer: "a case-control study of Turkish Oncology Group"

Diet and lifestyle related to socioeconomic status emerged as risk factors for gastric cancer in several studies. However, the results were not always consistent with the socioeconomic status. The aim of this study was to evaluate the risk factors independent from education as a measure of socioeconomic status. Two hundred and fifty-three patients with gastric cancer diagnosed in 2005 and equal number of control subjects were interviewed for several characteristics and diet. Matching was done for age, gender, city of residence and also for the level of education. Despite these matching preferences, patients had significantly lower income when compared to the control subjects (P = 0.0001). Higher rate of patients were smoking more than 2 packs/day of cigarettes (P = 0.018). Also significantly higher rate of control subjects were using antibiotics (P = 0.002). Coffee (P < 0.0001), salad (P = 0.006), bread (P = 0.005), vegetable-derived cooking oil (P = 0.003) consumptions appeared as highly protective factors against gastric cancer in univariate analysis in the present trial. In multivariate analysis, significant risk reducing factors were bread (P = 0.005) and coffee consumption (P = 0.0001) other than the level income (P = 0.002). In conclusion, the goal of obtaining comparable socioeconomic status by including the level of education in the matching criteria was not met in our study because of the difference in income level. The only risk reducing factor that was not in accordance with income level was the unexpectedly higher rate of bread consumption in control group.

Capecitabine and oxaliplatin (XELOX) as first-line treatment for patients with metastatic colorectal cancer

PURPOSE

For almost 40 years, 5-fluorouracil (5-FU) had been the only drug with demonstrated activity against (CRC), commonly used in combination with leucovorin (LV). Oxaliplatin and capecitabine are two relatively novel drugs used in the treatment of CRC. These drugs have been found to act synergistically, both in vivo and in vitro and their combination (XELOX) is highly active in metastatic colorectal cancer (mCRC). The aim of this study was to determine the safety and efficacy of XELOX in patients with mCRC.

METHODS

The study endpoints were response rates, toxicity, progression free (PFS) and overall survival (OS). XELOX was administered as first line treatment to patients with mCRC. Patient selection criteria included histological confirmation of mCRC, ECOG performance status (PS) <or=2, and adequate bone marrow, renal and hepatic function. Patients received oxaliplatin 130 mg/m(2) i.v., day 1, and oral capecitabine 1000 mg/m(2) twice daily, days 1-14, every 3 weeks.

RESULTS

34 patients were treated with XELOX; males/ females 23/11, median age 53.5 years (range 42-65), ECOG PS 0/1 52%/48%. Metastatic sites were the liver (23/34; 67%), lung (7/34; 20%), and bone (4/34; 11%). No patient achieved complete response (CR), 14 patients showed partial response (PR), 8 stable disease (SD) and 11 progressed (PD). Median PFS was 5.5 months, median OS 12.9 months and 1-year survival 52%.

CONCLUSION

The combination of oral capecitabine with i.v. oxaliplatin appears to be effective and well tolerated in patients with mCRC.

Larynx osteosarcoma: case report

We present the case of a laryngeal osteosarcoma in a 69-year-old man, which generated many diagnostic and treatment difficulties. The patient was admitted to the hospital because of persisting hoarseness and a laryngeal tumor was seen on laryngoscopy. Total laryngectomy was performed and the pathological examination of the resected material showed osteosarcoma of the larynx. Postoperative radiotherapy was planned but the patient declined any treatment. He was readmitted to the hospital 5 months later with a neck tumor and enlarged lymph nodes on the right side of the neck. Chemotherapy started and during treatment metastatic lymph nodes on the left side of the neck and pulmonary metastases were detected.

The symptomatic benefit (the clinical benefit response) from the second-line chemotherapy in patients with advanced gastric adenocarcinoma

There are few reports on use of symptomatic benefits as an alternative or adjunctive for the assessment of objective response in chemotherapy of the advanced cancer. This study is performed to assess the symptomatic benefits (the clinical benefit response), in addition to the efficacy and toxicity of cisplatin plus infusional 5-fluorouracil (5-FU) combination as second-line therapy in patients with advanced gastric cancer. Fifty-eight advanced gastric cancer patients with previous chemotherapy were enrolled into the study. Cisplatin 20 mg/m(2) was given for 5 days, and 5-FU was given 1000 mg/m(2) as 20 h continuous infusion for 5 days, repeated every 28 days. The overall objective response rate was 11.3%, and overall tumour control rate was 33.9%. The clinical benefit response, in terms of weight gain, reduction in analgesic consumption and the improvement in performance status observed in 12 patients [six patients with partial response (PR) and six patients with stable disease (SD)] (22.6%), while the rates of the clinical benefit response in patients with PR and with SD were 100% and 50% respectively. Cisplatin plus infusional 5-FU combination seems to improve disease-related symptoms (clinical benefit response) of patients with advanced gastric cancer, even in patients without objective response.

Efficacy of erythromycin for psoriasis vulgaris

Psoriasis is characterised by the presence of neutrophil overactivation and overproduction of interleukin (IL)-6 and IL-8 from keratinocytes. It is now clear that macrolide antibiotics have anti-inflammatory effects, such as inhibition of IL-6, IL-8 and tumour necrosis factor-alpha, perhaps by suppressing the transcription factor nuclear factor-kappaB or activator protein-1, and reduction of neutrophil activity. It is thus possible that macrolides might be a candidate for adjunctive treatment of psoriasis. In this study, we investigated the effectiveness of treatment with the macrolide antibiotic, erythromycin, for skin lesions and pruritus of patients with psoriasis. In total, 60 patients with psoriasis, especially pruritic psoriasis, were included. This was an open-label study and the analysis was on an intention-to-treat basis. Oral macrolide antibiotics and topical corticosteroids were given to the study group of 36 patients. The control group (24 patients) were treated only with topical corticosteroids. After a 4-week treatment period, scores on the Psoriasis Area and Severity Index (PASI) at baseline and at the end of the treatment, and the effectiveness in reducing itching were compared within and between both groups. Although there was no statistically significant difference between the baseline mean PASI of the two groups (P=0.81), there was a statistically significant difference between the mean PASI of the two groups at the end of the treatment (P=0.023, 95% confidence interval: - 3.45 to - 0.27). The comparison of the mean difference in PASI yielded a statistically significant difference (P=0.03, 95% confidence interval 0.73-3.55). Our study suggests that macrolides could be used as one of the adjunctive therapies for psoriasis vulgaris.

Opinions of the Turkish population on cancer and being informed for the diagnosis of cancer: An opinion survey

19680

Background: Opinions of the Turkish population on cancer, and their probable attitudes if one of their relative or themselves would have cancer diagnosis are investigated. Methods: The age, gender, profession, education levels of the subjects, their overall opinions on cancer are recorded by an opinion survey. Questions regarding if one of their first degree relatives had cancer, would they like the diagnosis being told to the patient and if they were to be the patient with cancer, would they prefer to be informed about the diagnosis are also asked. Results: 6566 subjects from various geographical regions of Turkey are participated in this survey. Participants’ median age were 33 years (range: 18–100), 53.3% were male. 57.7% of the participants would prefer to hide the cancer diagnosis from their first degree relatives. 54.8% of the participants had relatives with cancer and 69.9% of them said that the diagnosis had been told to the patient. The timing of the disclosure of the diagnosis were immediately in 71.5%, months after the diagnosis in 16.9% and in terminal stage in 9% of the patients. 62.8% of these patients are told to be died from cancer. When their overall opinion on cancer is asked, 76.5% were optimistic, 16.3% were pessimistic and did not believe the medicine, and 2.9% had both positive and negative opinions. Logistic regression analyses showed that 1) younger subjects; female subjects; subjects with lower education levels; subjects having a relative with cancer diagnosis which had not been revealed to the patient or revealed late in the course of the disease, or the patient had been died; subjects with pessimistic opinions about the treatment of the cancer were likely to hide the cancer diagnosis form their first degree relatives. 2) Elder subjects; subjects with lower education levels; subjects having a relative with cancer diagnosis which had been revealed to the patient; subjects having a relative with cancer diagnosis who died from cancer, subjects optimistic about cancer treatment; subjects preferring the diagnosis be hidden from patients were preferring not to be informed about the diagnosis if they were to have cancer. Conclusions: These results are comperable with reports form Eastern Europe and Asian countries.

No significant financial relationships to disclose.

Symptoms or signs due to different chemotherapeutics and their relationship with serum cytokines/VEGF levels in patients with cancer

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Background: Several problems such as myalgia, arthralgia, fever, dyspnea, generalised edema and pleural effusion and rarely “systemic capillary leak syndrome” may appear following the chemotherapy in cancer patients. Although it is supposed that some cytokines are associated with the development of these problems, there is no clear evidence for the relation between the cause and the effect. In this study, the relation between some symptoms following the first chemotherapy in cancer patients and the serum levels of interleukin-2 (IL- 2), interleukin-11 (IL-11), tumor necrosis factor alpha (TNF-a) and vascular endothelial growth factor (VEGF) which are supposed to cause these symptoms was investigated. Methods: Forty-four (28 male and 18 female) patients with cancer who had no heart, lung or renal diseases were consecutively enrolled to this study. Twenty-nine patients (27 with lung cancer, 1 with locally advanced gastric and 1 with pancreatic carcinoma) had active tumors. Fifteen patients (11 with breast cancer, 2 with gastric carcinoma, 1 with colon carcinoma, 1 with ovarian cancer) had no tumor because they were just curatively operated. Patients’ symptoms and findings due to chemotherapy were noted just before the chemotherapy and 24 hours later following chemotherapy. Patients’ serum samples were taken for the measurement of VEGF, TNF, IL-2 and IL-11 levels. Results: Any relation between the chemotherapeutic drugs and the symptoms or findings such as edema, dyspnea, cough and flu-like syndrome in patients were not observed. Otherwise, there were no relation with response to the chemotherapy and serum levels of VEGF, TNF, IL-2 and IL-11. But, patients who were not treated with paclitaxel, docetaxel, gemcitabine and vinorelbine showed a significant decrease in their IL-11 levels (p: 0.006). Conclusions: There was no statistically important difference between chemotherapeutics in terms of cytokine related effects. Although, there was no relation with response to the chemotherapy and serum cytokine levels, serum IL-11 levels were stable in patients administered with paclitaxel, docetaxel, gemcitabine and vinorelbine when compared with other drugs.

No significant financial relationships to disclose.

The effect of venous thromboembolism on survival of cancer patients and its relationship with serum levels of factor VIII and vascular endothelial growth factor: a prospective matched-paired study

BACKGROUND

Venous thromboembolism (VT) increases mortality and morbidity in cancer patients. The primary aim of this study was to evaluate the effect of VT on the survival of cancer patients and its relationship with serum vascular endothelial growth factor (VEGF) and plasma factor VIII levels.

PATIENTS AND METHODS

Eighty-two patients with locally advanced or metastatic cancer were included in this study between September 2001 and March 2004, and 31 of them had VT. Fifty-one matched-paired cancer patients without VT were prospectively selected as a control group in the same period. Criteria for the selection of control group patients were having the same malignancy, stage, metastatic site, performance status and age (+/-5 years) as patients in the VT group.

RESULTS

Plasma factor VIII and serum D-dimer levels in the VT group were significantly higher than those in the control group (p=0.030 and p=0.016, respectively). However, mean serum VEGF levels were similar in both groups (p=0.199). In the VT group, the median survival of patients who had higher serum VEGF levels (>150 pg/mL) was significantly shorter than that of patients in the same group with lower serum VEGF levels (p=0.005). The median survival of the VT group was 14 months, whereas it was 25 months in the control group (p=0.199).

CONCLUSION

There was a worse prognostic trend for cancer patients with VT. Nevertheless, the difference in survival was not statistically significant between the groups. Plasma factor VIII and serum D-dimer levels might have prognostic value in cancer patients with VT. Cancer patients with VT and higher serum VEGF levels had a significantly poorer prognosis.

Double superior vena cava

Duplication of superior vena cava (SVC) is a rare anomaly. The incidence of double SVC in general population is 0.3% whereas in patients with congenital heart disease it varies between 10-11%. Double SVC cases have clinical importance if especially the one on the left side drains into the left atrium. Moreover, double SVC is surgically important in the presence of congenital heart disease. In this article, we presented adult patients who incidentally diagnosed with double SVC, one drained into the right atrium while the other into the left atrium and discussed the embryologic basis of these patent vessels.