Tumour budding, uPA and PAI-1 are associated with aggressive behaviour in colon cancer

AIMS

The proteases PAI-1 and uPA play a major role in extracellular matrix degradation, which facilitates tumour progression. Tumour budding is a histomorphological expression of enhanced tumour cell migration.

MATERIALS AND METHODS

To investigate their prognostic value for and correlation with colon cancer, a prospective study was performed. We analysed tissue levels of uPA and PAI-1 of 55 colon cancer tumours employing a commercially available enzyme-linked immunosorbent assay (ELISA). Tumour budding was analysed on cytokeratin-stained slides.

RESULTS

There was a strong correlation between uPA and tumour budding (R = 0.440; P < 0.001). uPA levels were increased in high grade tumours, whereas PAI-1 was elevated in cases with venous invasion (P = 0.004 and P = 0.028). PAI-1 values and tumour budding are associated significantly with the occurrence of distant metastases (P < 0.001 and P = 0.034, respectively). Tumour budding was significantly associated with lymph node metastases (P = 0.034). Multivariate analysis revealed PAI-1 and lymph node metastases to be independently predictive of distant metastases (P = 0.007 and P = 0.004, respectively).

CONCLUSIONS

The results of our study show that tumour budding and the plasmin/plasminogen system are related. PAI-1 was independently predictive for the occurrence of distant metastasis.

[Ten years of epidemiological cancer registration in Bavaria]

For a large territorial state like Bavaria only a decentralised cancer registration structure promises successful results: in the form of regional clinical cancer registries and--using the clinical registration as a base--one population-based registry. After ten years of epidemiological cancer registration in Bavaria it can now be shown that the chosen registration concept has proved itself. Currently the completeness of cancer notifications exceeded the international recommended threshold of 90%. A largely complete data stock is available for the years of diagnosis from 2004 to 2005. The task sharing between clinical and population-based cancer registries avoids double registration of data. Both types of registries are supporting physicians and hospitals with a wide palette of services. Together they enable transparency of cancer occurrence as well as transparency of health care for tumour patients.

Effectiveness of a Disease Management Programme for Patients with Type 2 Diabetes Mellitus and Albuminuria in Primary Care - the PROSIT® Project (Proteinuria Screening and Intervention)

Aims. To evaluate the structured PROSIT(R) disease management programme for high-risk diabetic patients in primary care with respect to the cardio-vascular risk profile and mortality. Subjects and Methods. Retrospectively 55 albuminuric Type 2 diabetic patients included into the PROSIT(R) programme from 1994 to 1999 (intervention group: age 66.6 +/- 10.5 years, known duration of diabetes 8.9 +/- 6.5 years) were compared with 58 albuminuric patients not participating in the PROSIT(R) programme (control group: age 68.5 +/- 10.4 years, known duration of diabetes 8.5 +/- 6.7 years). Within PROSIT(R) a structured multifactorial intervention programme was applied. The main characteristics of this intervention were strict follow-ups of the patient's risk profile every three months and the use of quality management methods (definition of target values, structured documentation, central data feedback with diagnostic and therapeutic recommendations based on European guidelines). The cardio-vascular risk profile, therapeutic intervention, and secondary diabetic complications were compared between both groups in 1994 and 1999. Results. In the period from 1994 to 1999 the intervention group showed a significant improvement in the vascular risk profile, while the control group did not. In 1999 the mean arterial blood pressure was significantly lower compared to the control group (115 +/- 13 mm Hg vs. 125 +/- 16 mm Hg, p < 0.05). The HbA1c improved only in the intervention group and in 1999 it was significantly lower than in the control group (7.0 +/- 1.3 % vs. 8.4 +/- 1.8 %, p < 0.01). Moreover, the occurrence of clinical endpoints in the intervention group could be reduced: Both the mortalitly rate (14.5 % vs. 34.5 %, p < 0.05) and the rate of new myocardial infarctions (6 % vs. 20 %, p < 0.05) of the intervention group were significantly lower. Conclusions. Participation of albuminuric Type 2 diabetic patients and their physicians in a structured intervention programme showed positive effects on the cardio-vascular risk profile and endpoints compared with a group of non-participating patients and physicians.

[Ten-year trend of analgesic drug use (1984 to 1995): results of three MONICA-based surveys in Augsburg)]

BACKGROUND AND OBJECTIVE

Use of drugs, especially analgesics, is thought to be responsible for the rising cost of the health system in Germany, but there are no published population data for analgesic intake in Germany. Data derived from the three MONICA surveys (Monitoring of Trends and Determinants of Cardiovascular Diseases) in Augsburg and its adjacent districts were analysed for the prevalence of analgesic usage between 1984 and 1995 (the first such survey for Germany).

PATIENTS AND METHODS

A total of 5,899 males and 6,005 females (aged 25-64 years), representative of the population, were selected and examined in 1984/85, 1989/90 and 1994/95 (participation rate of those selected, 75-79%). Using a standardized protocol, all analgesic drugs taken during the previous 7 days were recorded and classified. The analysis was standardized for age and classified according to sex.

RESULTS

Strong analgesics were not significantly used under the ambulatory conditions of this survey and were therefore excluded from the analysis. Intake prevalence of mild to moderately strong analgesics varied from 5.9-8.9% in males and 9.9-13.4% in females. Prevalence was significantly at its lowest in 1989/90, but similar at the beginning and end of the 10-year period. Changes in prevalence of analgesic usage were similar to those of on-demand medication. Salicylic acid preparations containing higher dosages of the active ingredient were the drugs most commonly used, followed by aniline preparations, heteroaryl- as well as aryl-acetate and propionic acid derivates, pyrazole derivates, oxicam and anthranylic acid derivates.

CONCLUSION

The prevalence of taking mild of moderately strong analgesics was at a similar low level at the beginning and end of the 10-year period.

[Recurrent abdominal colic, myalgia and mononeuritis multiplex]

The case of a 30-year-old male, who presented with a three months history of fever, night sweats, weight loss and myalgia is reported. Subsequently abdominal cramps, bloody diarrhea and mononeuropathy multiplex developed. An abdominal and renal angiogram showed changes of vascular structures diagnostic for polyarteritis nodosa. An immunosuppressive treatment (Prednisolon 100 mg/day and Cyclophosphamid 200 mg/day) was started. However, diffuse peritonitis as the aftermath of bowel infarction, which comprised the total length of the jejunum and the proximal parts of the ileum, developed at the third week of this treatment. Despite immediate surgical resection of the ischemic bowel septic complications occurred and the patient died.

Effects of long-term treatment with anthranoids and sodium picosulphate on the contents of vasoactive intestinal polypeptide, somatostatin and substance P in the rat colon

OBJECTIVE

To examine the effects of chronic treatment and a single high-dose application of anthranoids and sodium picosulphate on the neuropeptide content of the rat colon.

DESIGN AND METHODS

Over a 6-month period, eight groups of rats were each given one of the following: sennosides or sodium picosulphate in low daily doses (10 and 2.5 mg/kg/day, respectively), in high daily doses (40 and 10 mg/kg/day, respectively), and in high twice-weekly doses (30 and 7.5 mg/kg/day, respectively); high daily doses of danthron (500 mg/kg/day); and vehicle (tragacanth 0.5%) only. Four further groups of rats each received a single dose of vehicle or a high dose of one of the three laxatives. All rats were killed 48 h after the last dose. The ascending and descending colon were removed and separated into mucosa, submucosa, and muscularis externa. Vasoactive intestinal polypeptide (VIP), somatostatin, and substance P were extracted by boiling and homogenizing the tissue in acetic acid, and their levels were determined using validated radioimmunoassays.

RESULTS

After long-term treatment with high doses of sennosides and danthron, but not after a single high-dose administration, there was a significant reduction in mucosal levels of VIP and somatostatin and in submucosal levels of somatostatin of both colonic segments, as well as in the level of VIP in the muscularis externa of the descending colon. Substance P levels remained unaffected. Sodium picosulphate had no effect.

CONCLUSIONS

Chronic treatment with anthranoids in high doses, but not with sodium picosulphate, reduces VIP and somatostatin levels in the rat colon. This may represent damage to the enteric nervous tissue or a pharmacological effect of the anthranoids, causing decreased synthesis or increased breakdown of these peptides.