The role of purinergic P2Y12 receptor blockers on the angiogenic properties of endothelial cells: an in vitro study

Pharmacotherapy with agents that inhibit platelet function has proven to be effective in the treatment of acute coronary syndrome. Proper re-endothelization after angioplasty prevents adverse cardiovascular events. Therefore, in this in vitro study we examined how antiplatelet P2Y₁₂ receptor blockers can affect endothelial cells' angiogenic properties. Endothelial cells were exposed to ticagrelor, prasugrel and clopidogrel in their highest concentrations obtained in serum after the treatment with loading and clinical doses. Further, the viability, apoptosis, and necrosis were tested and the following angiogenic properties such as proliferation, migration, invasiveness, tube formation, wound healing and the production of angiogenic mediators (bFGF, PDGF, MMP-2, Ang-2, TIMP-1). The results of this study showed that P2Y₁₂ receptor blockers in the tested concentrations are safe for endothelial cells. They neither induced necrosis or apoptosis nor changed the endothelial cell viability, migration, invasiveness, tube formation, wound healing, the production of VEGF or its receptors. However, they reduced cell proliferation. It was shown that out of these three drugs, ticagrelor in its loading concentration had the most potent angiogenic property. It reduced cell proliferation and changed the production of angiogenic (bFGF, MMP-2) and angiostatic mediators (Ang-2). In conclusion, P2Y₁₂ receptor blockers in the concentrations obtained in the serum during standard therapy reduced endothelial cell proliferation. Despite this slight antimitogenic effect, they did not change endothelial cell tube formation or wound healing. Out of the three tested drugs, ticagrelor had the most potent angiogenic effect in vitro, but not strong enough to disturb tube formation and wound healing.

Weight loss-dependent and -independent effects of moderate calorie restriction on endothelial cell markers in obesity

Endothelial cell dysfunction in obesity can be reduced by calorie restriction (CR), however it is unclear whether this benefit requires a concomitant weight loss or is it simply related to the reduced calorie intake per se. In our study serum was drawn from 41 obese women who were undergoing an 8-week dietary intervention with 15 - 30% energy deficit, and from 48 age- and sex-matched controls of normal weight. Serum was analysed for biomarkers of endothelial cell function, oxidative stress and inflammation. Compared with non-obese individuals, the obese patients had lower serum levels of nitric oxide (NO), adiponectin, and decreased serum antioxidant status. They also had significantly higher levels of adhesive molecules, thrombomodulin (TM), von Wilebrand factor (vWF), asymmetric dimethylarginine (ADMA), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and leptin. To further characterize the effect of moderate CR, the patients were ranked into two comparable groups according to the extent of weight loss - below and above the median (-5.8 kg). A moderate dietary intervention did not correct adiponectin, antioxidant status, vWF, TM, and plasminogen activator inhibitor-1 (PAI-1) but ameliorated changes in other parameters. Only changes in NO and - to a lesser degree - in sE-selectin showed a clear relationship with the magnitude of weight reduction. By contrast, a beneficial reduction in TNF-α occurred equally in patients who lost more or less weight after caloric restriction. We concluded that moderate calorie restriction could still improve several parameters of endothelial cell function irrespective of whether it was accompanied by changes in body mass. However, a significant improvement in nitric oxide, a key mediator of endothelial well-being, requires a substantial reduction in body weight.

1-(N-Trifluoroacetylamino)alkylphosphonic acids: synthesis and properties

The 1-(N-trifluoroacetylamino)alkylphosphonic acids (TFA-AA(P)) - sub-products in the synthesis of O,O-dialkyl 1-(N-trifluoroacetylamino)alkylphosphonates and O,O-diethyl 1-aminoalkylphosphonates, were synthesized in two-stage transformations of 1-aminoalkylphosphonic acids including: trifluoroacetylation of 1-aminoalkylphosphonic acids (AA(P)) using a trifluoroacetic anhydride/trifluoroacetic acid reagent (AA(P) + TFAA/TFA-->2) and subsequent hydrolysis of the intermediary compounds 2 into desired TFA-AA(P) (2-->TFA-AA(P)). These intermediates 2 presented mixtures of the type of mixed anhydrides of TFAA and 1-(N-trifluoroacetylamino)alkylphosphonic, pyrophosphonic and polyphosphonic acids, which underwent rapid and quantitative conversion to corresponding TFA-AA(P) during treatment with an excess of water. The title acids were isolated by direct evaporation of the corresponding post-reaction mixtures, and their physicochemical proprieties, including deacylation abilities, were determined. TFA-AA(P) compounds can be re-converted into the starting amino acids AA(P) under respectively mild conditions (AA(P)-->TFA-AA(P)-->AA(P)).

Education / training in supportive and palliative care in central and eastern Europe. Results of a questionnaire survey

During the totalitarian era terminal care was excluded from the health care system, and oncology, including education in the field, was rather neglected. The political and economic reforms that started in the 1990s in the countries of eastern and central Europe enhanced the development of palliative care and improvements in cancer treatment standards. This survey was performed to assess the current status of education and training in supportive and palliative care. A questionnaire was prepared and distributed by the authors to national leaders in palliative/supportive care. Data obtained from 16 countries indicate progress in palliative care provision and education, though it is held up by economic difficulties and by the lack of regulations in countries engaged in reforms of their health care systems. Training in supportive care is deficient; the discipline is usually perceived as the management of side-effects of anticancer treatment, so that it is not separated from clinical oncology. Access to professional literature should be improved, and the creation of national literatures should be encouraged. The role of local leaders, NGOs and professional associations must be emphasized. The main goals are: improvement of education, and better quality and availability of palliative and supportive care, not only for patients with cancer but also in other progressive life-threatening diseases.

Effect of bacteriological status on pressure ulcer healing in patients with advanced cancer

OBJECTIVES

This study aimed to identify the quantitative and qualitative bacteriological status of pressure ulcers in patients with advanced cancer, and the effects on the healing process.

METHOD

We recruited 34 patients with advanced cancer who had 38 superficial grade II and III pressure ulcers. Patients were randomly allocated to treatment with Lyofoam/polyurethane foam dressing (Seton) or Aquagel/hydrogel dressing (Wytw.Opatrunków). Efficacy, treatment times and healing rates were noted. Qualitative studies were undertaken on 38 pressure ulcers and quantitative bacteriological studies on 19 ulcers.

RESULTS

There was no statistical difference between the two treatment groups in efficacy, healing rates and treatment times. Bacteriological assessment identified 92 species.

CONCLUSION

The bacteria did not cause any clinical signs of infection. Variations in the number and types of bacteria in individual wounds did not correlate to the grade of ulcer or the dressing used.

Type I 5'-iodothyronine deiodinase activity and mRNA are remarkably reduced in renal clear cell carcinoma

The purpose of this study was to compare thyroid hormone metabolism between non-cancerous tumor-surrounding human kidney tissues and renal clear cell carcinomas (RCCC). The material consisted of samples taken from 10 RCCC patients of both sexes and three grades of differentiation, G1 to G3. We showed that, similar to rat tissue, type I 5' monodeiodinase (5'DI) expression is heterogeneous within the human kidney. We also found a poor correlation between 5'DI activity and mRNA level in non-cancerous tumor-surrounding tissue suggesting significant post-transcriptional regulation of 5'DI expression by an unidentified process in the human kidney. In all RCCC tissues both 5'DI activity and mRNA levels were undetectable. This suggests either loss of human 5'DI gene expression during neoplastic transformation or the origination of RCCC from a tubular cell type that does not express 5'DI.

The effects of midazolam and morphine on analgesic and sedative activity of ketamine in rats

The aim of this study was to investigate possible interactions between the analgesic activity of ketamine (an N-methyl-D-aspartate antagonist), midazolam (a benzodiazepine derivative) and morphine using the tail-flick test in rats. Animals were treated s.c. with ketamine (1.0-10.0 mg/kg), midazolam (0.3 mg/kg), or morphine (0.6 mg/kg) alone. or in combination The strongest analgesic effect of ketamine was observed after 3.0 mg/kg. In higher doses no enhancement of ketamine activity were found. After morphine and ketamine (3.0 mg/kg) or morphine, midazolam and ketamine co-administration. higher antinociceptive effects compared to ketamine activity were found. Rats administered midazolam and ketamine (3.0 mg/kg) showed a decrease of the effect of ketamine analgesia, and the antinociceptive effect of the three-component mixture was lower than after co-injection of morphine and ketamine. The interaction of these two compounds with ketamine (5.0 mg/kg) occurred in a different manner, because midazolam led to a strong enhancement of ketamine analgesia. After morphine and ketamine (5.0 mg/kg) administration, very weak increase of ketamine analgesia was observed. The results of this study allow better understanding of the alteration of the analgesic effects of low doses of ketamine under the influence of morphine and midazolam.

[Research from the Palliative Care Department in Poznań on treatment of neoplasm pain with Durogesic (transdermal fentanyl)]

Transdermal Fentanyl (TF, Durogesic) is a strong opioid analgesic which is used in the treatment of cancer pain. In this article we described basic properties and dosing guidelines for TF and our own experience with use of Durogesic in the treatment of cancer pain. In this open study TF was administered in 16 pts aged of 30-88 (mean 62 +/- 17) years with advanced cancer who suffered from strong cancer pain and who had previously been treated with morphine (11 pts), buprenorphine (1 pt), tramadol (2 pts) and non-opioid analgesics (2 pts). Analgesic efficacy and side-effects of TF were appraised. The time of the treatment was 7-235 (mean 77 +/- 58) days, the dose range 25-600 (mean 129 +/- 117) micrograms/h. The mean initial dose of Durogesic was 94 +/- 99 micrograms/h and the final dose of fentanyl patch was 156 +/- 149 micrograms/h. Good analgesic effect was achieved in 11 pts (69%), partial effect in 2 pts (12%), unsatisfactory analgesia in 3 pts (19%). The treatment was well tolerated and the most frequent adverse reactions were constipation in 10 pts (63%) and drowsiness in 4 pts (25%). During the therapy with TF we didn't encounter serious side-effects which would cause cessation of the treatment. Results of our study confirmed that TF was an effective analgesic most commonly used in pts with stable nociceptive pain especially when opioid analgesics could not be administered orally.

Potential uses of topical opioids in palliative care--report of 6 cases

Opioids used topically may exercise several useful clinical effects. Opioids may cause immediate local analgesia and also may work indirectly through decreasing the inflammation process. In this article we describe six patients treated with topical opioids because of cutaneous pain due to tumor infiltration. skin ulcers of malignant and non-malignant origin, severe oral mucositis, pain due to knee arthrosis and severe tenesmoid pain. In all but one case, topical morphine provided rapid relief which lasted usually for 7-8 h. The side effects of topical opioids were none or minimal. Possible mechanisms of topical analgesia are discussed.

managing pressure sores in palliative care

This report discusses improvements in the prevention and management of pressure sores among patients with terminal illnesses

[The quality of life in particular phases of disease in women treated for genital neoplasms]

The authors have performed psychological analysis in women with diagnosed neoplasma of the genital organs. All of them were treated with radiotherapy. The quality of life depended on the phase of the disease in which they had been.

Palliative/hospice care in Poland

The first hospice in eastern Europe was the Hospicium in Krakow, which was created 10 years ago. Three years later the leading independent Polish hospice, Hospitium Pallotinum, was founded in Gdansk. This hospice helped to organize more than 20 similar groups, usually Catholic agencies which offer home care programmes. The University Palliative Care Service in the Academy of Medical Sciences in Poznan, which was created in 1988, consists of a home care team caring for 600 patients a year and has a seven-bed inpatient unit. It offers an education programme for physicians, nurses, medical and pharmacy students as well as a research programme. There is currently an academic link between the Poznan Palliative Care service and Sir Michael Sobell House in Oxford, sharing medical and nursing education in palliative care. The educational courses and conferences have been attended by international speakers offering education which will help to change the attitudes of professional health care workers and the public. We hope that the Polish Ministry of Health and Welfare and the government will be interested in establishing policies that will cover the cost of palliative care in the newly developing health care system.

The use of respirators in patients with complicated myocardial infarction

The results of controlled respiration as treatment in 20 patients with complicated myocardial infarction are presented. The clinical indications to this method of treatment included: shock, pulmonary oedema refractory to treatment, recurrent ventricular fibrillation and respirator failure following cardiac arrest. An indication for the use of this method is a drop in PaO2 below 70 mm Hg despite breathing 30% oxygen. Neuroleptanalgesic drugs were administered routinely while the patient was on the respirator. In all cases at least two prognostically unfavourable clinical signs were found. A correlation was observed between the clinical result and hypoxaemia after breathing 100% oxygen.

[The clinical significance of controlled artificial respiration in patients with acute myocardial infarct]

It is reported on the results of the treatment with artificial ventilation in 20 patients with complicated myocardial infarction. As indicating sign a decreased arterial PO2 (lower than 70 Torr at an respiration of 50% O2 in the respiration air) was considered. Further references to clinical indications were depression of the breathing centre, severe pulmonary oedema, shock and life-threatening therapy-resistent disturbances of the rhythm. The long-term successes of the treatment with controlled respiration showed a clear dependence on the severity of the cardiac lesion and the general condition of the patient. In 10 cases only a transient improvement could be achieved. Three patients survived.