Clinical validation of nuclear factor kappa B expression in invasive breast cancer.

Breast cancer is the most commonly diagnosed cancer in Polish women. The expression of transcription nuclear factor kappa B, a key inducer of inflammatory response promoting carcinogenesis and cancer progression in breast cancer, is not well-established. We assessed the nuclear factor kappa B expression in a total of 119 invasive breast carcinomas and 25 healthy control samples and correlated this expression pattern with several clinical and pathologic parameters including histologic type and grade, tumor size, lymph node status, estrogen receptor status, and progesterone receptor status. The data used for the analysis were derived from medical records. An immunohistochemical analysis of nuclear factor kappa B, estrogen receptor, and progesterone receptor was carried out and evaluation of stainings was performed. The expression of nuclear factor kappa B was significantly higher than that in the corresponding healthy control samples. No statistical difference was demonstrated in nuclear factor kappa B expression in relation to age, menopausal status, lymph node status, tumor size and location, grade and histologic type of tumor, and hormonal status (estrogen receptor and progesterone receptor). Nuclear factor kappa B is significantly overexpressed in invasive breast cancer tissues. Although nuclear factor kappa B status does not correlate with clinicopathological findings, it might provide important additional information on prognosis and become a promising object for targeted therapy.

Insulin-induced enhancement of MCF-7 breast cancer cell response to 5-fluorouracil and cyclophosphamide.

The study was designed to evaluate the potential use of insulin for cancer-specific treatment. Insulin-induced sensitivity of MCF-7 breast cancer cells to chemotherapeutic agents 5-fluorouracil and cyclophosphamide was evaluated. To investigate and establish the possible mechanisms of this phenomenon, we assessed cell proliferation, induction of apoptosis, activation of apoptotic and autophagic pathways, expression of glucose transporters 1 and 3, formation of reactive oxygen species, and wound-healing assay. Additionally, we reviewed the literature regarding theuse of insulin in cancer-specific treatment. We found that insulin increases the cytotoxic effect of 5-fluorouracil and cyclophosphamide in vitro up to two-fold. The effect was linked to enhancement of apoptosis, activation of apoptotic and autophagic pathways, and overexpression of glucose transporters 1 and 3 as well as inhibition of cell proliferation and motility. We propose a model for insulin-induced sensitization process. Insulin acts as a sensitizer of cancer cells to cytotoxic therapy through various mechanisms opening a possibility for metronomic insulin-based treatments.

Assessment of prescription pattern of under-five diarrhea cases in Western Odisha.

Introduction: Diarrhea is the second leading cause of death among under-five children. Prescription review by the authorities of the health facilities every month for the improvement of the quality of prescription writing of Medical practitioners is very essentials. With this background, the present study was conducted to assess the prescription patterns of healthcare providers for under-five diarrhea cases and to study the factors responsible for nonadherence to protocol of prescription patterns. Methodology: This cross-sectional study was conducted in the health facilities of two aspirational districts of Odisha. All secondary- and tertiary-level health institutions with 2-3 randomly selected PHCs of that blocks of the two districts were the study units. Mixed methods were used for data collection. Primary data were collected by in-depth interview of doctor and pharmacist. Secondary data were collected by review of records such as OPD ticket, IPD ticket, OPD register, dispensing register, and stock registers. Results: Of the 64 health facilities visited, a total of 516 prescriptions [217 (42%)] scanned/carbon copy of OPD ticket, 238 (46%) data from register on drug prescription, and 61 (11.8%) IPD record data were collected. Duration of diarrhea illness was not mentioned in any of the prescriptions which is important criteria for classifying the type of diarrhea and treatment. Signs of dehydration and degree of dehydration were mentioned in very few prescriptions of both the district. For the treatment of diarrhea cases, 2 to 4 medicines were prescribed in majority of 146 (67.3%), followed by more than four medicines in 38 (17.5%) prescriptions, and less than two medicines were prescribed in 33 (15.2%) cases. All prescriptions from MCH and SDH had ORS and zinc. Though all of them knew about the management protocol as per IMNCI, to be on the safe onside they used to prescribe more medicines to under-five diarrhea cases. None had the knowledge on five types of management plan. Conclusion: For under-five diarrhea cases, care should be taken to write the detail examination finding, weight of the child, associated comorbid condition, and advice on feeding in the prescription.

Effects of the menstrual cycle phases on the tilt testing results in vasovagal patients.

PURPOSE: The aim of the study was to assess the distribution of positive tilt testing (TT) throughout the menstrual cycle and to determine if the phase of menstrual cycle contributes to the duration of the loss of consciousness. METHODS: TT results of 183 premenopausal women, aged 29.5 ± 9.8 years, were studied. The menstrual cycle was divided into four phases based on the first day of the last menstrual bleeding: perimenstrual (M), preovulatory (F), periovulatory (O) and postovulatory (L). RESULTS: Positive TT results were equally distributed. In patients with TT in O phase, the highest percentage of NTG provocation was needed. Patients in L phase had significantly lower incidence of cardioinhibitory reaction. The longest duration of loss of consciousness was in the M phase. Multiple regression analysis revealed that the duration of loss of consciousness during positive TT was significantly associated with higher number of syncopal events, TT performed in M phase and lower heart rate at TT termination. Cardiodepressive type of neurocardiogenic reaction was more frequent during M and O phase than during L phase. CONCLUSIONS: The distribution of positive TT results as well as syncope and presyncope does not differ throughout the menstrual cycle. Diagnostic TT in premenopausal women with unexplained syncope could be performed irrespective of the phase of menstrual cycle. TT has similar sensitivity throughout the menstrual cycle. During the postovulatory phase, cardioinhibitory reaction is less frequent than in M and O phases. The duration of loss of consciousness is longer during the M phase of the menstrual cycle independently of the higher syncope number and lower heart rate at TT termination.

The risk for syncope and presyncope during surgery in surgeons and nurses.

BACKGROUND: Surgeons and nurses are exposed to orthostatic stress. AIMS: To assess the lifetime incidence of syncopal and presyncopal events during surgery in operation room staff and reveal the predicting factors. METHODS AND RESULTS: The study included 317 subjects (161 F, 156 M) aged 43.9 ± 9.6; 216 surgeons and 101 instrumenters. The study included filling of an anonymous questionnaire on the syncope and presyncope history. RESULTS: At least one syncopal event during operation was reported by 4.7% and presyncope by 14.8% of the studied population. All but one subject reported prodromal symptoms before syncope. In the medical history, syncope outside the operating room was reported by 11% of the studied group. Syncope and presyncope during operation was related to syncope in the medical history outside the operation room, respectively: odds ratio (OR) 20.2 95% confidence interval (CI): 2.0-70.5 and OR 10.8; CI: 5.0-23.4 and to presyncope in the medical history, respectively: OR 23.5; CI: 7.4-74.4 OR 8.9; CI: 3.6-11.2 (P < 0.001). CONCLUSIONS: (1) Syncope and presyncope may occur during surgery in the staff of the operating room. (2) Syncope in the operating room is usually preceded by prodromal symptoms and has vasovagal origin. (3) Both lower then expected occurrence of syncope in the operating room staff and absence of any difference between genders in this regard indicate preselection in the process of choosing profession and specialization. (4) Syncope and presyncope outside the operating room in medical history increases the risk of syncope and presyncope inside the operation room.

Large-Scale Proteomic Analysis of Follicular Lymphoma Reveals Extensive Remodeling of Cell Adhesion Pathway and Identifies Hub Proteins Related to the Lymphomagenesis.

Follicular lymphoma (FL) represents the major subtype of indolent B-cell non-Hodgkin lymphomas (B-NHLs) and results from the malignant transformation of mature B-cells in lymphoid organs. Although gene expression and genomic studies have identified multiple disease driving gene aberrations, only a few proteomic studies focused on the protein level. The present work aimed to examine the proteomic profiles of follicular lymphoma vs. normal B-cells obtained by fine-needle aspiration biopsy (FNAB) to gain deep insight into the most perturbed pathway of FL. The cells of interest were purified by magnetic-activated cell sorting (MACS). High-throughput proteomic profiling was performed using liquid chromatography-tandem mass spectrometry (LC-MS/MS) and allowed to identify of 6724 proteins in at least 75% of each group of samples. The 'Total Protein Approach' (TPA) was applied to the absolute quantification of proteins in this study. We identified 1186 differentially abundant proteins (DAPs) between FL and control samples, causing an extensive remodeling of several molecular pathways, including the B-cell receptor signaling pathway, cellular adhesion molecules, and PPAR pathway. Additionally, the construction of protein-protein interactions networks (PPINs) and identification of hub proteins allowed us to indicate the key player proteins for FL pathology. Finally, ICAM1, CD9, and CD79B protein expression was validated in an independent cohort by flow cytometry (FCM), and the results were consistent with the mass spectrometry (MS) data.

The clinical relevance of the duration of loss of consciousness provoked by tilt testing.

OBJECTIVE: The authors assessed the relationships between the duration of loss of consciousness (dLOC) during tilt testing-induced syncope (TTS) and demographics, medical history as well as tilt testing results. Previous research focused on the relevance of the type of neurocardiogenic reaction during TTS. The importance of dLOC has not been assessed so far. The study was carried out in 274 patients with suspected neurally mediated syncope and total loss of consciousness during tilt testing. RESULTS: The syncope burden, demographics, and data regarding spontaneous syncope orTTS were compared between group I with dLOC > or =47 seconds and group 2 with dLOC <47 seconds. Medical history revealed that patients in group I had more syncopal spells, more frequent syncope-related traumatic injuries, urine incontinence, jerking movements and typical vasovagal history than in group 2. Moreover, group I patients had more frequently a cardioinhibitory type of reaction and a shorter active phase duration. In addition, they manifested more frequent accompanying cerebral hypoperfusion signs and reproduction of symptoms during TTS than patients in group 2. CONCLUSIONS: The loss of consciousness during tilt testing-induced syncope differs in terms of duration among patients with neurally mediated syncope. The dLOC during TTS is associated with medical history and tilt-testing data which confirm the vasovagal aetiology of spontaneous events. The longer dLOC suggests deeper cerebral haemodynamic disturbances during either spontaneous or provoked syncope.

Clinical relevance of syncope and presyncope induced by tilt testing.

OBJECTIVE: The authors investigated the relation between presyncope and syncope induced by tilt testing (HUTT) and demographics, medical history and HUTT data.The demographics, syncopal burden, data regarding the spontaneous syncope and reproduction of symptoms during HUTT were compared among patients with induced syncope and presyncope. The study group consisted of 574 patients (371 women, 203 men), aged 43.7 +/- 18.5 years. METHODS AND RESULTS: Patients with syncope induced by HUTT (418 patients, 63.9% women) had a higher number of syncopal episodes in their medical history. Stepwise logistic regression revealed that syncope provocation was independently related to the cardiodepressive type of neurocardiogenic reaction (OR 7.8, CI 4.2-14.4, P < 0.001), NTG use (OR 1.7, CI: 1.0-2.7, P < 0.05), the reproduction of the symptoms during HUTT (OR 2.0, CI: 1.3-3.1, P < 0.01) and the higher number of syncopal episodes (OR 2.0, CI: 1.3-3.0, P < 0.01). In patients with positive HUTT during a passive phase it was related to the cardiodepressive type of reaction (OR 26.5, CI: 5.9-118.5, P < 0.001). In the group with positive HUTT after NTG syncope was related to the cardiodepressive type (OR 5.7, CI: 2.9-11.2, P < 0.001), vasovagal history (OR 2.0, CI: 1.2-3.3, P < 0.01), reproduction of the spontaneous symptoms (OR 1.9, CI: 1.1-3.1, P < 0.05) and higher number of syncopal episodes (OR 2.1, CI: 1.3-3.3, P < 0.01). CONCLUSIONS: Syncope is more frequently a HUTT outcome than presyncope. The provocation of syncope in the passive phase of HUTT depends only on the cardiodepressive type of neurocardiogenic reaction. The induction of presyncope after nitroglycerin provocation is related to the possibility of a false positive reaction.

Predictors of mortality in older patients admitted to a geriatric hospital.

AIM: The identification of older patients at risk of mortality is important to provide properly tailored care and effectively manage healthcare resources. The present study aimed to identify predictors of all-cause mortality related to geriatric patients' clinical, functional and sociodemographic status at admission. METHODS: A retrospective study was carried out of patients admitted to a geriatric hospital from January to May 2013. A total of 208 patients were enrolled in the study. The outcome measure was 4-year mortality. RESULTS: The mortality rate was 26%. We found that age, red blood cells count and white blood cells count, as well as C-reactive protein level, albumin level and high-density lipoprotein cholesterol level significantly correlated with mortality. Furthermore, the presence of clinical symptoms, such as pressure ulcers and depressed level of consciousness, was predictive of poor outcome. Multidimensional aspects of aging that are assessed in the Comprehensive Geriatric Assessment - activities of daily living, instrumental activities of daily living, Barthel scale, Mini-Mental State Examination and The Clock Drawing Test - appeared to be strong predictors of 4-year mortality. The expression to estimate the probability of mortality based on the examined variables correctly classified nearly 85% of the analyzed cases. CONCLUSIONS: Early detection of high-risk patients is of particular significance to reach a better survival rate among older adults. Clinicians should put more stress on the comprehensive surveillance of geriatric patients, rather than focusing solely on the treatment of chronic diseases. Geriatr Gerontol Int 2019; 19: 70-75.

Insulin enhancement of the antitumor activity of chemotherapeutic agents in colorectal cancer is linked with downregulating PIK3CA and GRB2.

The present state of cancer chemotherapy is unsatisfactory. New anticancer drugs that marginally improve the survival of patients continue to be developed at an unsustainably high cost. The study aimed to elucidate the effects of insulin (INS), an inexpensive drug with a convincing safety profile, on the susceptibility of colon cancer to chemotherapeutic agents: 5-fluorouracil (FU), oxaliplatin (OXA), irinotecan (IRI), cyclophosphamide (CPA) and docetaxel (DOC). To examine the effects of insulin on cell viability and apoptosis, we performed an in vitro analysis on colon cancer cell lines Caco-2 and SW480. To verify the results, we performed in vivo analysis on mice bearing MC38 colon tumors. To assess the underlying mechanism of the therapy, we examined the mRNA expression of pathways related to the signaling downstream of insulin receptors (INSR). Moreover, we performed Western blotting to confirm expression patterns derived from the genetic analysis. For the quantification of circulating tumor cells in the peripheral blood, we used the maintrac method. The results of our study show that insulin-pretreated colon cancer cells are significantly more susceptible to commonly used chemotherapeutics. The apoptosis ratio was also enhanced when INS was administered complementary to the examined drugs. The in vivo study showed that the combination of INS and FU resulted in significant inhibition of tumor growth and reduction of the number of circulating tumor cells. This combination caused a significant downregulation of the key signaling substrates downstream of INSR. The results indicate that the downregulation of PIK3CA (phosphatidylinositol 3-kinase catalytic subunit alpha), which plays a critical role in cell signaling and GRB2 (growth factor receptor-bound protein 2), a regulator of cell proliferation and differentiation may be responsible for the sensitizing effect of INS. These findings were confirmed at protein levels by Western blotting. In conclusion, these results suggest that INS might be potentially applied to clinical use to enhance the therapeutic effectiveness of chemotherapeutic drugs. The findings may become a platform for the future development of new and inexpensive strategies for the clinical chemotherapy of tumors.

[The usefulness of contrast-enhanced sonography in the differential diagnostic of adrenal tumors]. / Przydatnosc ultrasonograficznego srodka kontrastujacego Levovist w diagnostyce róznicowej guzów nadnerczy.

INTRODUCTION: The occurrence of gland tumors causes significant clinical problem. Non hormone-secreting tumors provide the most complicated diagnostic difficulties. The application of contrast-enhanced sonography could improve the vessels visualization and point out characteristic features of benign and malignant changes. The authors believe that this new method make possible the differential adrenal tumor diagnostic process more precise and increase the specificity of ultrasonography in the recognition of benign and malignant tumors. The aim of this study was to define the usefulness of contrasting agent Levovist in differential diagnostics of adrenal tumors and its influence on sensitivity and specificity of ultrasound examination and to establish patients qualification criteria for surgical procedures. MATERIAL AND METHODS: Ultrasound examinations were made with the use of digital devise by GE Voluson 740, probe 4-6 mHz with Doppler options and volumetric probe 3D according to the following protocol: 26 patients with recognized adrenal tumor were qualified for the examination. Patients in the first stage of tumor vascularization had Doppler examination with color (CD) and power Doppler (PD). Three-dimensional ultrasonography was used to improve visualization of vascularization. In the final phase of the examination the patients were administrated of Levovist in the recommended by the producer dose: 2.5 g in the concentration of 400 mg/l. RESULTS: 26 cases of adrenal gland tumours were subjected to analysis. In standard ultrasonographic examination focal changes in 25 patients were hipoechogenic focuses and in one case the focus was hyperechogenic. Heterogeneity of focuses was observed in 16 cases. In Doppler examination with color (CD) and power Doppler (PD) vascular blood flow was revealed within 12. After using contrasting agent Levovist vascular blood flow was achieved in 4 additional cases, which constituted 61%. CONCLUSIONS: 1. 3D ultrasound could be useful in cases of big adrenal tumors--over 3 cm diameter after application of ultrasound contrast agents. 2. The use of Levovist in Doppler examination improves the visualization of tumor vascularization. However, it is impossible to differentiate benign from malignant tumors unequivocally.

Pancreatic heterotopia in the gallbladder: an incidental finding after cholecystectomy.

Ectopic pancreas in the gallbladder is found very rarely in histological examination after cholecystectomy. The etiology of this entity is not yet clear, but there exist several hypotheses about its origin. Our histological study revealed both exocrine and endocrine components of pancreatic tissue as shown by H&E and immunohistochemical staining of a gallbladder sections of a 55-year old man. Ectopic pancreatic tissue may be an underestimated cause of acute idiopathic pancreatitis thus detailed postoperative histological examination may decrease the number of acute pancreatitis cases without the known cause.

Clinical and biochemical factors affecting postoperative hypocalcemia after near-total thyroidectomy.

BACKGROUND: The most common complication which occurs after thyroidectomy is postoperative hypocalcemia due to parathyroid gland damage. It usually appears 24-48 hours postoperatively, but there are clinical and biochemical factors which may contribute to its earlier diagnosis. OBJECTIVES: The aim of this study was to assess clinical and biochemical factors which can influence postoperative hypocalcemia after near-total thyroidectomy. MATERIAL AND METHODS: The material consisted of 103 patients with benign nodular goiter. In all patients the blood samples were taken 4 times and levels of total calcium, magnesium, inorganic phosphorus, parathormone and thyroid-stimulating hormone were measured. One day before surgery and during the first three days postoperatively patients were asked about symptoms of hypocalcemia and the presence or absence of a Trousseau sign was observed. RESULTS: There was no statistically significant connection between the symptoms of hypocalcemia and the age of patients and preoperative hyperthyroidism. Patients with symptomatic hypocalcemia had longer operating time, resected tissue weighed more and hospitalization time was longer than in patients without symptoms of hypocalcemia. Concomitant occurrence of hypocalcemia and hypomagnesemia postoperatively was found in 16% of patients. Changes in parathyroid hormone concentration measured 10 min after thyroid excision were more sensitive and specific for detecting patients with symptomatic hypocalcemia after surgery than total calcium concentration. CONCLUSIONS: Measurement of intraoperative parathormone level 10 min after thyroidectomy is a highly sensitive and specific factor for detecting postoperative hypocalcemia. If we connect this parameter with some other clinical features, it will be possible to predict postoperative hypocalcemia more accurately and introduce supplementation as early as possible.

The choice of surgical specialization by medical students and their syncopal history.

BACKGROUND: The aim of the study was to assess whether medical students' fainting outside the university or while witnessing surgical procedures and/or autopsies influenced their choice of a specialization. MATERIALS AND METHODS: The study group consisted of 605 medical students (from fourth to sixth year of study) from five medical universities in Poland (325 women, 212 men and 8 responders of an unspecified gender). The median age of subjects studied was 23 years, and the interquartile range was 23-24 years. The students at each university were chosen randomly by the author who worked there and had contact with them. An anonymous questionnaire was developed to gather information regarding demographics, the specialization which each student wanted to choose, the syncope occurrence in the medical history, the syncope and presyncope occurrence during surgery and autopsy as well as the syncopal events' characteristics. RESULTS: The group of 15% of women and 30% of men declared to have pursued the surgical specialization (P<0.001), 29% of women and 56% of men declared the intention to pursue an invasive specialization (P<0.001). As many as 36.0% of women studied and 13.1% of men studied reported syncopal spells outside university (P<0.001). Only 41 students (6.8%) reported that syncope or presyncope in any studied circumstances had an impact on their specialization choice. The multivariate analysis showed that the choice of surgical specialization is related to the male gender and the absence of syncopal spells outside the university. CONCLUSIONS: Syncopal and presyncopal spells may affect the professional choices of the medical students. The male gender and a lack of syncope occurrence outside operating room are related to the choice of surgical specialization.

[The relevance of junctional rhythm during neurocardiogenic reaction provoked by tilt testing].

BACKGROUND: During neurocardiogenic reaction provoked by tilt testing (TT), different arrhythmias such as sinus bradycardia, sinus arrest, atrioventricular block or junctional rhythm or beats (JR) may occur. The characteristics of the JR during neurocardiogenic reaction have not yet been systematically assessed. It is not known whether the presence of JR during neurocardiogenic reaction is related to clinical characteristics of syncopal patients or the outcome of TT. AIM: To assess whether clinical outcome of TT and clinical data are related to the presence of JR during TT. METHODS: The study group consisted of 532 patients aged 43.3 ± 18.2 years with positive TT, divided into four groups on the basis of the presence of JR and/or a ventricular pause (VP) during neurocardiogenic reaction: group VP(-)/JR(+) - JR present and VP absent, group VP(+)/JR(+) - both JR and VP present, group VP(+)/JR(-) - JR absent and VP present, and group VP(-)/JR(-) - both JR and VP absent. The control group consisted of 53 patients with no history of syncope or presyncope, including 46 patients with negative TT and seven patients with false positive TT. RESULTS: Total loss of consciousness during TT occurred in group VP(-)/JR(+) less frequently than in groups VP(+)/JR(+) and VP(+)/JR(-), and more frequently than in group VP(-)/JR(-) (80% vs 96% vs 94% vs 62%; p 〈 0.05 for both comparisons). Group VP(-)/JR(+) was significantly younger than group VP(-)/JR(-) (37.3 ± 16.3 years vs 45.8 ± 18.9 years; p 〈 0.05) and had a lower number of syncopal events than group VP(+)/JR(+) and VP(+)/JR(-) (median [IQ]: 2.5 (1-6) vs 4 (2-12) and 4 (2-10), respectively; p 〈 0.05) and lower rate of traumatic injuries than group VP(+)/JR(+) and VP(+)/JR(-) (22% vs 45% and 39%, respectively; p 〈 0.05). Logistic regression analysis revealed that the presence of JR was associated with younger age, male gender, history of blood-instrumentation-injection phobia and higher number of syncopal spells in medical history. The ROC curve analysis revealed that a junctional rate of no more than 49 bpm was related to the total loss of consciousness during TT (p 〈 0.05). CONCLUSIONS: 1. JR frequently occurs during positive TT and in no subjects with negative TT. 2. Among patients with JR, two groups may be chosen on the basis of a VP occurrence, and these groups differ in respect to clinical characteristics and TT outcome. 3. Relatively rapid JR without VP is related to consciousness preservation during neurocardiogenic reaction at TT and fewer syncopal spells as well as syncope associated with injury in the past. 4. In patients with JR and VP, the JR is slower, of shorter duration, and more frequently single or pairs of junctional beats occur, which indicates high parasympathetic activity, whereas relatively rapid and stable JR may be the symptom of simultaneously increased sympathetic and parasympathetic activity.

Control of active B and L cathepsins in tissues of colorectal cancer using cystatins isolated from chicken egg proteins: in vitro studies.

The activity of cysteine peptidases (cathepsins B and L) was estimated in homogenates of tissues sampled during surgery from 60 patients operated due to colorectal tumors. The results were compared to those obtained using tissues in which histopathology disclosed no tumorous cells, obtained from 20 patients of the same group, treated as a control. Activity of the enzymes was inhibited using cysteine peptidase inhibitors isolated from chicken egg proteins. Application of the inhibitors was found to inhibit activity of the enzymes which play a key role in tumor development. It is suggested that in future the inhibitors may provide a component of new generation drugs in the so-called inhibitor therapy.

Inhibition of cysteine peptidase activity in ascitic fluid in pancreatic cancer patients.

The work's objective is to answer the question whether there is any possibility of activity inhibition of cysteine peptidases inhibitors playing an important role in key processes accompanying cancer formation, including pancreas. There is a justified speculation that specific inhibitors of these enzymes may inhibit development of cancer processes by inhibiting their activity. In vitro studies confirmed that these enzymes in ascitic fluid were inhibited with egg whites inhibitors even to 90% of their original activity.

Cysteine peptidases and their inhibitors in breast and genital cancer.

Cysteine proteinases and their inhibitors probably play the main role in carcinogenesis and metastasis. The metastasis process need external proteolytic activities that pass several barriers which are membranous structures of the connective tissue which includes, the basement membrane of blood vessels. Activities of the proteinases are regulated by endogenous inhibitors and activators. The imbalance between cysteine proteinases and cystatins seems to be associated with an increase in metastatic potential in some tumors. It has also been reported that proteinase inhibitors, specific antibodies for these enzymes and inhibition of the urokinase receptor may prevent cancer cell invasion. Some proteinase inhibitor could serve as agents for cancer treatment.

Molecular markers (c-erbB-2, p53) in breast cancer.

The aim of our study was to evaluate the correlation between clinical characteristics, histopatologic features and c-erbB-2 as well as p53 expression in cancer tissues. Breast cancer tissue was obtained from 184 female subjects with primary breast cancer. According to hormonal status patients were divided into two groups - 64 belonged to the premenopausal group and 120 to postmenopausal group. Each patient underwent mammectomy and axillary lymphadenectomy. c-erbB-2 protooncogene was detected in 54% cases, and was correlated with infiltrating type of cancer growth, as well as larger tumor size. The presence of p53 antioncogene was observed only in 33% of cases, mainly in infiltrating duct carcinomas. The incidence of c-erbB-2 and p53 positive cases was higher among subjects, whose ultrasound and mammography revealed malignancy. There was no correlation found between of c-erbB-2 expression and axillary lymph nodes involvement It seems probable, that c-erbB-2 and p53 status of cancer tissue may prove to be useful in assessment of the level of biological aggressiveness in breast carcinomas and hence can be used as a prognostic factor.