Relationship between the number of lost teeth and the occurrence of depressive symptoms in middle-aged adults: a cross-sectional study.

BACKGROUND: Many recent studies suggest the existence of a relationship between oral health and the occurrence of depressive symptoms. The aim of this study was to assess the relationship between the number of lost teeth and the occurrence of depressive symptoms in middle-aged adults. METHODS: An analysis was performed on the data obtained from the PONS project (POlish-Norwegian Study), conducted in the Swietokrzyskie Province in Poland in 2010-2011. The research material included the cross-sectional data of 11,901 individuals aged 40-64 years (7967 women). Depressive symptoms, used as outcome variables, were assessed with a questionnaire. The participants provided the responses to questions concerning the occurrence of eight symptoms over the last 12 months. The answers were scored as 1 point or 0 points. The participants were divided into three tercile groups based on their total scores: no or mild (0-2 points), moderate (3-5 points), and severe depressive symptoms (6-8 points). The self-reported number of lost teeth was analysed according to the following categories: 0-4, 5-8, 9-27, and a complete lack of natural teeth. Multivariable logistic regression analysis for depressive symptoms was used in relation to the number of lost teeth. The following covariates were included in the adjusted model: age, sex, place of residence, education, marital status, BMI, diabetes status, stressful life events in the last year, use of antidepressants, smoking, and sugar and sweet consumption. RESULTS: The likelihood of both moderate (OR = 1.189; 95%CI: 1.028-1.376; p < .020) and severe (OR = 1.846; 95%CI: 1.488-2.290; p < .001) depressive symptoms showed the strongest relationship with a total lack of natural teeth. A loss of more than 8 natural teeth was also significantly associated (OR = 1.315; 95%CI: 1.075-1.609; p < .008) with the occurrence of severe depressive symptoms. CONCLUSIONS: The loss of natural teeth was positively related to the occurrence of depressive symptoms in middle-aged adults. Thus, there is an urgent need to intensify stomatological prophylaxis, education and treatment for middle-aged individuals.

Current trends in bariatric surgery in patients older than 65 years in Poland.

<b><br>Introduction:</b> It is already known that bariatric surgery can improve the health and quality of life of morbidly obese patients of all ages. Our population is getting older. That is why the number of bariatric surgeries among obese people over 65 years of age is systematically increasing.</br> <b><br>Aims:</b> The study aims to analyze the management of patients over 65 years of age in Polish bariatric centers.</br> <b><br>Material and methods:</b> The study was conducted on representatives from the 30 largest bariatric departments in Poland. By collecting surveys, we aimed to analyze changes in qualifications for surgery and care for elderly patients.</br> <b><br>Results:</b> 13 of 30 (43.3%) representatives responded to the survey. The remaining centers did not qualify patients over 65 years old for the surgical treatment of obesity. The mean percentage of patients over 65 who underwent bariatric surgery was 2.75. Most representatives (69.2%) chose SG as the procedure of choice in patients over 65 years of age. According to 84.6% of surgeons, age did not matter when qualifying patients over 65 years of age for BS. The majority of surgeons (53.8%) believed that bariatric surgery in older patients was comparable to the one in younger patients. Nine (69.2%) surgeons believed that there should be no age limit for bariatric surgery.</br> <b><br>Conclusions:</b> Only almost half of the bariatric centers in Poland perform operations on patients over 65 years of age. Most Polish surgeons claim that operations on older and on younger patients have comparable benefits, and that there is no need for age limit.</br>.

The impact of lifestyle, measured with the HLPCQ questionnaire on the prevalence of metabolic syndrome in Poland: a multicenter study.

Metabolic syndrome is one of the most common health problems for people around the world. The aim of our study was to assess the prevalence of metabolic syndrome among adults without prior diagnosis of cardiovascular disease, diabetes, and chronic kidney disease. We also plan to assess the influence of certain lifestyle components on prevalence of metabolic syndrome. The study involved cardiovascularly healthy patients undergoing lab tests, measurements, and the HLPCQ questionnaire (The Healthy Lifestyle and Personal Control Questionnaire). The data were used to diagnose metabolic syndrome. Out of 1044 patients from 10 primary care facilities, 23.3% met the metabolic syndrome criteria, showing a strong link with increased blood pressure, cholesterol, and fasting glucose. Lower scores in the Organized physical exercise subscale of the HLPCQ questionnaire were noted in those with metabolic syndrome. Comparing the subscale of HLPCQ questionnaire, the lower results in Organized physical exercise subscale were found among the participants with metabolic syndrome, both male and females. Metabolic syndrome, a significant risk factor for cardiovascular disease, should be screened for actively, even in apparently healthy populations. Results obtained in our study from analysis of HLPCQ show that screening for metabolic syndrome should be preceded by prevention based on regular physical activity and proper eating habits.

Managing Undernutrition in Pediatric Oncology: A Consensus Statement Developed Using the Delphi Method by the Polish Society for Clinical Nutrition of Children and the Polish Society of Pediatric Oncology and Hematology.

"Managing Undernutrition in Pediatric Oncology" is a collaborative consensus statement of the Polish Society for Clinical Nutrition of Children and the Polish Society of Pediatric Oncology and Hematology. The early identification and accurate management of malnutrition in children receiving anticancer treatment are crucial components to integrate into comprehensive medical care. Given the scarcity of high-quality literature on this topic, a consensus statement process was chosen over other approaches, such as guidelines, to provide comprehensive recommendations. Nevertheless, an extensive literature review using the PubMed database was conducted. The following terms, namely pediatric, childhood, cancer, pediatric oncology, malnutrition, undernutrition, refeeding syndrome, nutritional support, and nutrition, were used. The consensus was reached through the Delphi method. Comprehensive recommendations aim to identify malnutrition early in children with cancer and optimize nutritional interventions in this group. The statement underscores the importance of baseline and ongoing assessments of nutritional status and the identification of the risk factors for malnutrition development, and it presents tools that can be used to achieve these goals. This consensus statement establishes a standardized approach to nutritional support, aiming to optimize outcomes in pediatric cancer patients.

Blood Lead Level as Marker of Increased Risk of Ovarian Cancer in BRCA1 Carriers.

BRCA1 mutations substantially elevate the risks of breast and ovarian cancer. Various modifiers, including environmental factors, can influence cancer risk. Lead, a known carcinogen, has been associated with various cancers, but its impact on BRCA1 carriers remains unexplored. A cohort of 989 BRCA1 mutation carriers underwent genetic testing at the Pomeranian Medical University, Poland. Blood lead levels were measured using inductively coupled plasma mass spectrometry. Each subject was assigned to a category based on their tertile of blood lead. Cox regression analysis was used to assess cancer risk associations. Elevated blood lead levels (>13.6 µg/L) were associated with an increased risk of ovarian cancer (univariable: HR = 3.33; 95% CI: 1.23-9.00; p = 0.02; multivariable: HR = 2.10; 95% CI: 0.73-6.01; p = 0.17). No significant correlation was found with breast cancer risk. High blood lead levels are associated with increased risk of ovarian cancer in BRCA1 carriers, suggesting priority for preventive salpingo-oophorectomy. Potential risk reduction strategies include detoxification. Validation in diverse populations and exploration of detoxification methods for lowering lead levels are required.

Predictors of outcomes of patients ≥ 80 years old admitted to intensive care units in Poland - a post-hoc analysis of the VIP2 prospective observational study.

INTRODUCTION: Elderly patients pose a significant challenge to intensive care unit (ICU) clinicians. In this study we attempted to characterise the population of patients over 80 years old admitted to ICUs in Poland and identify associations between clinical features and short-term outcomes. MATERIAL AND METHODS: The study is a post-hoc analysis of the Polish cohort of the VIP2 European prospective observational study enrolling patients > 80 years old admitted to ICUs over a 6-month period. Data including clinical features, clinical frailty scale (CFS), geriatric scales, interventions within the ICU, and outcomes (30-day and ICU mortality and length of stay) were gathered. Univariate analyses comparing frail (CFS > 4) to non-frail patients and survivors to non-survivors were performed. Multivariable models with CFS, activities of daily living score (ADL), and the cognitive decline questionnaire IQCODE as predictors and ICU or 30-day mortality as outcomes were formed. RESULTS: A total of 371 patients from 27 ICUs were enrolled. Frail patients had significantly higher ICU (58% vs. 44.45%, P = 0.03) and 30-day (65.61% vs. 54.14%, P = 0.01) mortality compared to non-frail counterparts. The survivors had significantly lower SOFA score, CFS, ADL, and IQCODE than non-survivors. In multivariable analysis CFS (OR 1.15, 95% CI: 1.00-1.34) and SOFA score (OR 1.29, 95% CI: 1.19-1.41) were identified as significant predictors for ICU mortality; however, CFS was not a predictor for 30-day mortality ( P = 0.07). No statistical significance was found for ADL, IQCODE, polypharmacy, or comorbidities. CONCLUSIONS: We found a positive correlation between CFS and ICU mortality, which might point to the value of assessing the score for every patient admitted to the ICU. The older Polish ICU patients were characterised by higher mortality compared to the other European countries.

Speciation analysis of arsenic in honey using HPLC-ICP-MS and health risk assessment of water-soluble arsenic.

It is well known that arsenic is one of the most toxic elements. However, measuring total arsenic content is not enough, as it occurs in various forms that vary in toxicity. Since honey can be used as a bioindicator of environmental pollution, in the present study the concentration of arsenic and its species (As(III), As(V), DMA, MMA and AsB) was determined in honey samples from mostly Poland and Ukraine using HPLC-ICP-MS hyphenated technique. The accuracy of proposed methods of sample preparation and analysis was validated by analyzing certified reference materials. Arsenic concentration in honey samples ranged from 0.12 to 13 µg kg-1, with mean value of 2.3 µg kg-1. Inorganic arsenic forms, which are more toxic, dominated in honey samples, with Polish honey having the biggest mean percentage of inorganic arsenic species, and Ukrainian honey having the lowest. Furthermore, health risks resulting from the consumption of arsenic via honey were assessed. All Target Hazard Quotient (THQ) values, for total water-soluble arsenic and for each form, were below 1, and all Carcinogenic Risk (CR) values were below 10-4, which indicates no potential health risks associated with consumption of arsenic via honey at average or recommended levels.

Health status in selected post-communist European countries: a comparative study between Poland and Albania.

OBJECTIVES: The aim of this analysis was to compare selected health status indicators of the Albanian and Polish populations, pertinent to two former communist countries in Central and Eastern Europe (CEE). METHODS: This analysis was based on the estimates related to the Global Burden of Disease (GBD) 2019 study, reported by the Institute for Health Metrics and Evaluation (IHME). For Poland, IHME uses data mainly from the Central Statistical Office of Poland, whereas for Albania the information is based on the reports from the National Institute of Statistics. RESULTS: In 2019, life expectancy at birth was slightly higher in Albania compared to Poland (78.5 years vs. 78.1 years, respectively). Mortality rate from noncommunicable diseases was similar in both countries (about 520 deaths per 100,000 population). In 2019, the main risk factor for the overall mortality in both countries was the high systolic blood pressure. In Albania, high systolic blood pressure accounted for almost 32% of deaths from all causes, whereas in Poland it accounted for only 21% of all deaths. The second main risk factor in Albania concerned the dietary factors which were responsible for almost one in four deaths. In Poland, the second main risk factor for all-cause mortality concerned tobacco which was responsible for one in five deaths. The third leading risk factor in Albania was tobacco (responsible for one in five deaths), whereas in Poland it concerned the dietary risks (responsible for about 19% of the all-cause mortality). CONCLUSIONS: This analysis provides useful information about the current health status of two populations pertinent to the former Communist Bloc in CEE. While health indicators can provide important information about the differences in health status between populations, it is important to interpret these indicators in the context of the specific challenges and limitations facing each country.

Evaluation of potentially toxic elements and microplastics in the water treatment facility.

The potentially harmful effects of consuming potentially toxic elements (PTEs) and microplastics (MPs) regularly via drinking water are a significant cause for worry. This study investigated PTEs (Cd, Cu, Cr, Ni, Pd, Zn, Co), MPs, turbidity, pH, conductivity, and health risk assessment in the water treatment plant in Kielce, Poland. Zn had the highest concentrations throughout the water treatment facility, whereas Cd, Pb, and Co had lower concentrations (< 0.1 µg/L). The order of the concentrations among the specified PTEs was like Zn˃Cu˃Ni˃Cr˃Cd˃Pb and Co. The minimum turbidity was 0.34, and the maximum was 1.9 NTU. The range of pH in water samples was 6.51-7.47. The conductivity was 1,203-1,445 ms in water samples. These identified MPs were categorized into fiber and fragments. The color of these identified MPs was blue, red, black, green, and transparent. The minimum and maximum size of the MPs was 196 and 4,018 µm, while the average size was 2,751 ± 1,905 µm. The average concentration of MPs per liter of the water treatment plant was 108.88 ± 55.61. The elements listed are C, O, Na, Mg, Al, Si, K, Ca, and Ti. Fe and Zn were the predominant elements seen using EDX. HQ values of the PTEs were less than one for adults and children. The human health risk associated with all detected PTEs revealed that the HQ values exhibit a satisfactory degree of non-carcinogenic adverse health risk. HI values for adults and children age groups were less than one. In most water treatment samples, the carcinogenic value exceeds the threshold value of 10-6. The PTEs and MP concentrations in drinking water should be periodically monitored to minimize consumers' environmental pollution and health risks.

Health-Related Behaviours of Foreign Students Studying in Poland and Their Determinants: A Mixed-Methods Study.

Educational migration benefits students and receiving countries, but universities are challenged to meet a variety of needs, such as cultural adaptation and changes in health behaviours such as dietary habits. This study aimed to assess the health-related behaviours, encompassing dietary/eating habits, among international students in Poland, while also elucidating the factors influencing these behaviours. The study consisted of two phases: (phase 1) cross-sectional research among 231 foreign students using the Fantastic Lifestyle Questionnaire (FLQ); and (phase 2) focus group interviews with 15 international students. The study was conducted in accordance with STROBE (STrengthening the Reporting of OBservational studies in Epidemiology) and COREQ (COnsolidated criteria for REporting Qualitative research) Checklists. It was shown that the respondents highly value health. Students' health-related behaviours are related to their financial situation, health condition, self-assessment of their lifestyle, the importance attached to being healthy, and their country of origin. The qualitative analysis allowed us to identify (1) the barriers related to the exhibiting of health-related behaviours, (2) expectations of foreign students regarding the exhibiting of health-related behaviours, (3) changes in the health-related behaviours, and (4) factors facilitating the exhibiting of health-related behaviours. There is a need for inter-university cooperation on a strategy to promote health-promoting behaviours of foreign students studying in Poland.

Association of the bitter taste genes TAS2R38 and CA6 and breast cancer risk; a case-control study of Polish women in Poland and Polish immigrants in USA.

It is known that the perception of bitterness is mediated by type 2 bitter taste receptors (TAS2Rs). However, recent reports have suggested that the carbonic anhydrase 6 (CA6) gene may also influence bitterness sensing. Genetic variants in these genes could influence dietary intake of brassica vegetables, whose increased consumption has been observed in the literature, though inconsistently, to decrease breast cancer (BC) risk. We hypothesized that the estimated odds ratios (ORs) for the association between BC and taster diplotype (PAV/PAV) and/or genotype A/A, will be in the direction of increased BC risk, potentially due to reduced consumption of brassica vegetables. Using a case-control study of BC in Polish women in Poland (210 cases and 262 controls) and Polish immigrant women to USA (78 cases and 170 controls) we evaluated the association of the taster diplotypes in TAS2R38 gene and genotypes in the CA6 gene and BC risk in these two populations individually and jointly. No significant increase in risk was observed for the TAS2R38 PAV/PAV diplotype (tasters) in each population individually or in the joint population. For the CA6 gene, in the joint population, we observed an increased BC risk for the combined G/A and G/G genotypes (non-tasters) vs A/A (tasters), OR = 1.41 (95% CI 1.04-1.90, p = 0.026) which after adjustment for False Discovery Rate (FDR), was not significant at p≤0.05 level. However, for the joint population and for the combined genotype of the two genes AVI/AVI+G* (non-tasters) vs. PAV/*+A/A (tasters), we observed a significant increase in BC risk, OR = 1.77 (95%CI 1.47-2.74, p = 0.01), for the non-tasters, which remained significant after FDR adjustment. In conclusion for the joint population and the joint effect for the two bitter sensing genes, we observed an increase in BC risk for the bitterness non-tasters, association which is in the opposite direction to our original hypothesis.

Ceratophyllum demersum the submerged macrophyte from the mining subsidence reservoir Nadrybie Poland as a source of anticancer agents.

Aquatic plants are a rich source of health-beneficial substances. One of such organisms is the submerged macrophyte Ceratophyllum demersum, which has not been sufficiently studied in this aspect so far. In this work, we have studied environmental conditions prevailing in a subsidence mining reservoir in Eastern Poland and shown that C. demersum can be harvested for further analysis even from artificial anthropogenic reservoirs. The phytochemical analysis of C. demersum ethanolic extract using LC-MS revealed high content of phenolic compounds (18.50 mg/g) (mainly flavonoids, 16.09 mg/g), including those that have not yet been identified in this plant, namely isorhamnetin, sakuranetin, taxifolin, and eriodictyol. Such rich flavonoid content is most likely responsible for the anticancer activity of the C. demersum extract, which was targeted especially at neoplastic cells of gastrointestinal tract origin. The flow cytometry analysis of treated cells showed an increased percentage of late apoptotic and necrotic cells. The fish embryo toxicity (FET) test showed safety of the extract towards Danio rerio fish up to the concentration of 225 µg/ml. This study has shown that the submerged macrophyte Ceratophyllum demersum can be taken into consideration as a rich source of a set of anticancer agents with chemopreventive potential.

Concentration of trace elements in blood of Polish patients with prostate cancer.

The goal of the study was to analyse the concentrations of chemical elements (Fe, Ni, As, Cd, Pb, Hg, Cr, Zn) which are important for the determination of environmental toxins (e.g. resulting from smoking, exposure to harmful agents at work) in Polish patients with prostate cancer. The study covered 66 patients with diagnosed prostate cancer and 64 healthy volunteers over 50 years old. The analysis of the concentrations of selected chemical elements in whole blood was performed using inductively coupled plasma mass spectrometry (ICP-MS). In their blood, the patients with cancer had a significantly higher concentration of only one of the examined elements: arsenic. Additionally, the study group had lower concentrations of chromium, zinc, but also cadmium and lead, which are commonly regarded as carcinogenic. Taking into consideration the control group of healthy subjects of this study, we can assume that the subjects with prostate cancer were exposed to higher levels of arsenic, and that exposure to this element may be associated with an increased risk of cancer.

Is There a Link between Thyroid Peroxidase Gene Promoter Polymorphisms and Autoimmune Thyroiditis in the Polish Population?

(1) Autoimmune thyroiditis (AIT) is the most common cause of primary hypothyroidism and one of the most frequent organ-specific autoimmune diseases. Its pathogenesis is polygenic and still requires further research. The aim of the study was to assess, for the first time in the Caucasian population, the role of selected TPO gene promoter polymorphisms (rs2071399 G/A, rs2071400C/T, rs2071402 A/G, and rs2071403 A/G) in the development of AIT. A total of 237 patients diagnosed with AIT and 130 healthy controls were genotyped for four TPO gene polymorphisms, and the results were statistically analyzed to check for the role of these polymorphisms. There were no significant differences in the genotype and allele frequencies of the studied TPO gene promoter polymorphisms between patients and controls (p > 0.05). The haplotype distribution (rs2071400-rs2071402-rs2071403) between the two studied groups was similar for the most common variants (CGA, CAG, TGG). Only a rare haplotype (CGG) occurred more frequently among patients compared to controls (p = 0.04). The studied TPO gene promoter polymorphisms did not show an association with susceptibility to AIT in the Caucasian Polish population, contrary to the results in Japanese patients.

Savings in social expenditures for work incapacity in patients with inflammatory bowel disease depend on access to innovative therapies in Poland.

OBJECTIVES: Inflammatory bowel diseases (IBD) are an increasing burden for societies. We examined Polish Social Insurance Institution (ZUS) work incapacity expenditures for people with IBD compared with the general population. METHODS: Aggregate data were obtained on ZUS expenditures between 2012 and 2021 in Polish zlotys (PLN). Annual work incapacity benefit expenditures were analyzed and IBD benefit expenditures were examined relative to innovative IBD drug utilization in individual provinces. RESULTS: Between 2012 and 2021, annual ZUS expenditures per person increased, while expenditures per IBD patient decreased. Proportionally, absenteeism was the largest ZUS expenditure in the general population, while disability pensions were the largest in the IBD population. ZUS expenditures due to absenteeism in the general population increased by PLN 282 per person; those due to disability pensions decreased by PLN 85. Disability pension spending due to Crohn's disease (CD) and ulcerative colitis (UC) decreased by PLN 371 and PLN 284, respectively, while absenteeism spending per person with CD and UC decreased (PLN 58 and PLN 35, respectively). Nationwide in 2021, 8.5% of people with CD and 1.9% of those with UC received innovative drugs. The percentage of people receiving innovative drugs and ZUS expenditure per person were inversely related in 9/16 provinces for CD and 5/16 for UC. CONCLUSION: Polish state spending on work incapacity benefits increased in the general population but decreased in people with IBD between 2012 and 2021. Use of innovative drugs was associated with reduced spending per person with IBD in some provinces.

Analytical Assessment of the Antioxidant Properties of the Coneflower (Echinacea purpurea L. Moench) Grown with Various Mulch Materials.

Antioxidants are added to foods to decrease the adverse effect of reactive species that create undesirable compounds that destroy essential nutrients and, therefore, lower the nutritional, chemical and physical properties of foods. This study was carried out to determine the antioxidant properties of flowers and plant stems with leaves of Echinacea purpurea grown with mulches of different colours and thicknesses. Coneflowers were grown in the Experimental Station of the Agricultural University in Kraków, Poland. The mulching materials used were black, green and brown colours of 100 g/m2 and 80 g/m2 density. In plant material, e.g., flowers or plant stems plus leaves the proximate analysis, the total polyphenol content and the ability to scavenge free radicals (ABTS, DPPH and FRAP) were determined. The results show that flower samples had a higher content of compound proteins, ash and phenolic compounds. The mulching colour and density did not affect the proximate analysis of the E. purpurea plant. Based on the result of this study, E. purpurea is a potential source of natural antioxidants and can be used to improve the antioxidant activity of various food products as well as in cosmetics within the pharmaceutical industry.

Risk factor analysis and clinicopathological characteristics of female dogs with mammary tumours from a single-center retrospective study in Poland.

This is a comprehensive retrospective study to characterize female dogs with canine mammary tumors (CMTs) using a dataset retrieved from the archives of the Division of Animal Pathology, Institute of Veterinary Medicine in Warsaw, and to identify prognostic factors. Clinical and histopathological data of 1447 dogs with CMTs were included. Malignant tumours were found in 83.3% (n = 1206), benign tumours in 11.7% (n = 169), and non-neoplastic lesions in 5.0% (n = 72) of dogs. Dogs most often had grade II carcinomas (38.2%, 215/562) of a single histological subtype (88.5%, 1281/1447), mostly simple carcinoma (35.3%, 510/1447). Dogs with a median age of 10 years significantly often had larger (≥ 3 cm) and malignant CMTs, whereas intact females had smaller tumours (median size 2.0 cm). However, the threshold value for the age of the dog in the differentiation of malignant and non-neoplastic/benign masses could not be determined. Most females were hormonally active (76.4%, 372/487). Hormonally active dogs significantly more often had multiple tumours. Multiple tumours were significantly smaller (median 2.5 cm) than single ones. Among pedigree dogs, small-breed dogs were mostly recorded (43%, 428/1006). Twelve breeds had an increased risk of CMTs, regardless of tumour behaviour, compared with the theoretical distribution of pedigree dogs in Poland. Four breeds were often affected only by malignant and other four breeds only by non-neoplastic/benign CMT. Large-breed dogs were significantly younger and affected by larger CMT (median 4 cm) compared with small- and medium-breed dogs. Ninety dogs with a malignant CMT and complete records were included in the full analysis of CMT-specific survival (CMT-SS) with a median follow-up time of 20.0 months. We showed that the timing of ovariohysterectomy in relation to mastectomy was significantly associated with grade, CMT-SS, and CMT-related death. We indicated the low diagnostic accuracy of palpation of regional lymph nodes (RLN) in the prediction of their metastatic involvement. By multivariable analysis, dogs with neoplastic emboli, tumour ulceration, and simple or complex carcinoma had a significantly higher risk of local recurrence. Tumour size > 3 cm was as a strong independent predictor of lung metastases. Compared with dogs with an easily separated localized tumour, dogs with a multiple/diffuse malignant CMT pattern had a fivefold higher risk of death. The risk of death was significantly higher in the presence of neoplastic emboli (~ fivefold) and tumour ulceration (~ fourfold). Furthermore, the presence of neoplastic emboli and large tumour size were independent predictors of CMT-related death.