Role of saliva in esophageal defense: implications in patients with nonerosive reflux disease.

BACKGROUND: It has been previously demonstrated that patients with reflux esophagitis exhibit a significant impairment in the secretion of salivary protective components versus controls. However, the secretion of salivary protective factors in patients with nonerosive reflux disease (NERD) is not explored. The authors therefore studied the secretion of salivary volume, pH, bicarbonate, nonbicarbonate glycoconjugate, protein, epidermal growth factor (EGF), transforming growth factor alpha (TGF-α) and prostaglandin E2 in patients with NERD and compared with the corresponding values in controls (CTRL). METHODS: Salivary secretion was collected during basal condition, mastication and intraesophageal mechanical (tubing, balloon) and chemical (initial saline, acid, acid/pepsin, final saline) stimulations, respectively, mimicking the natural gastroesophageal reflux. RESULTS: Salivary volume, protein and TGF-α outputs in patients with NERD were significantly higher than CTRL during intraesophageal mechanical (P < 0.05) and chemical stimulations (P < 0.05). Salivary bicarbonate was significantly higher in NERD than CTRL group during intraesophageal stimulation with both acid/pepsin (P < 0.05) and saline (P < 0.01). Salivary glycoconjugate secretion was significantly higher in the NERD group than the CTRL group during chewing (P < 0.05), mechanical (P < 0.05) and chemical stimulation (P < 0.01). Salivary EGF secretion was higher in patients with NERD during mechanical stimulation (P < 0.05). CONCLUSIONS: Patients with NERD demonstrated a significantly stronger salivary secretory response in terms of volume, bicarbonate, glycoconjugate, protein, EGF and TGF-α than asymptomatic controls. This enhanced salivary esophagoprotection is potentially mediating resistance to the development of endoscopic mucosal changes by gastroesophageal reflux.

A distinct salivary secretory response mediated by the esophago-salivary reflex in patients with Barrett's esophagus: its potential pathogenetic implications.

PURPOSE: A significantly compromised epidermal growth factor (EGF) secretion by basal parotid saliva may contribute to the development of Barrett's esophagus (BE). The rate of secretion of EGF as well as a wide spectrum of protective factors in total basal and stimulated saliva in BE patients remains to be explored. We therefore studied the rate of secretion of salivary buffers, glycoconjugate, protein, EGF, transforming growth factor α (TGFα) and prostaglandin E2 (PGE2), evoked by esophago-salivary reflex, in patients with BE and controls (CTRL). MATERIAL/METHODS: Salivary secretion was collected during basal condition, mastication, and intraesophageal mechanical and chemical stimulations respectively, mimicking the natural gastroesophageal reflux scenario. RESULTS: Salivary pH in BE was significantly lower than in controls during mechanical (p<0.001) and chemical stimulations (p<0.001). Bicarbonate and protein outputs in BE were significantly lower during mechanical (p<0.05) and chemical stimulations (p<0.01). The non-bicarbonate and glycoconjugate outputs in BE were lower during chemical stimulation (p<0.05) and during mechanical (p<0.05) and chemical stimulations (p<0.05) respectively. The rate of salivary EGF output in BE was significantly lower during mechanical stimulation (p<0.05). We observed a higher TGFα output during mastication (p<0.05) and PGE2 secretion during basal and masticatory condition (p<0.05) in BE. CONCLUSIONS: Patients with BE demonstrated significantly compromised salivary pH and rate of secretion of bicarbonate, non-bicarbonate, glycoconjugate, protein and EGF. This impairment could potentially predispose to the development of accelerated esophageal mucosal injury. Potential restoration of this impairment by masticatory stimulation of salivary secretion using sugarless chewing gum justifies further clinical exploration.

[Implementation of cytology images classification--the Bethesda 2001 System--in a group of screened women from Podlaskie region--effect evaluation]. / Ocena efektów wdrozenia klasyfikacji obrazów cytologicznych wg systemu Bethesda 2001, w populacji kobiet województwa podlaskiego poddanych badaniom profilaktycznym.

UNLABELLED: Increasing knowledge concerning carcinogenesis within cervical epithelium has forced us to make continues modifications of cytology classification of the cervical smears. Eventually, new descriptions of the submicroscopic cytomorphological abnormalities have enabled the implementation of Bethesda System which was meant to take place of the former Papanicolaou classification although temporarily both are sometimes used simultaneously. AIM: The aim of this study was to compare results of these two classification systems in the aspect of diagnostic accuracy verified by further tests of the diagnostic algorithm for the cervical lesion evaluation. MATERIALS AND METHODS: The study was conducted in the group of women selected from general population, the criteria being the place of living and cervical cancer age risk group, in the consecutive periods of mass screening in Podlaski region. The performed diagnostic tests have been based on the commonly used algorithm, as well as identical laboratory and methodological conditions. RESULTS: Performed assessment revealed comparable diagnostic accuracy of both analyzing classifications, verified by histological examination, although with marked higher specificity for dysplastic lesions with decreased number of HSIL results and increased diagnosis of LSILs. Higher number of performed colposcopies and biopsies were an additional consequence of TBS classification. Results based on Bethesda System made it possible to find the sources and reasons of abnormalities with much greater precision, which enabled causing agent treatment. CONCLUSION: Two evaluated cytology classification systems, although not much different, depicted higher potential of TBS and better, more effective communication between cytology laboratory and gynecologist, making reasonable implementation of The Bethesda System in the daily cytology screening work.

[The role of peroxisome proliferator-activated receptors (PPAR) in carcinogenesis]. / Udzial receptorów aktywujacych proliferacje peroksysomów (PPAR) w karcinogenezie.

Peroxisome proliferators-activated receptors are members of the nuclear hormone receptor superfamily of ligand-activated transcription factors. The PPAR subfamily consists of three members: PPAR-alpha, PPAR-sigma (NUC-1 or beta) and PPAR-gamma. PPARs regulate gene expression by binding, as heterodimers with retinoid X receptors (RXR), to specific response elements (PPREs) in the promoter regions of target genes. The prostaglandin 12 especially, all arachidonic acid metabolites and polyunsaturated fatty acids are naturally occuring PPAR ligands. Synthetic PPAR ligands are thiazolidinediones (TZDs--rosiglitazone, pioglitazone, troglitazone). Activation of nuclear hormone receptors has been identified as an approach to induce differentiation and inhibit proliferation of cancer lines. The anti-proliferative, pro-differentiation effects of PPAR activators (TZDs) suggest that these compounds might be useful in slowing the proliferation of un-differentiated tumour cells. TZDs inhibit proliferation of human breast, prostate and colon cancers, both in vitro and in tumours derived from these cells implanted into rodents. Furthermore, recent studies show that PPAR-gamma ligands are potent inhibitors of angiogenesis, a process essential for solid-tumour growth and metastasis. In conclusion, the evidence to date suggests that activation of PPAR should suppress tumour growth and development. This represents an exciting novel therapeutic application of TZDs. In present paper, structural features of PPARs, their gene transcription mechanisms and recent developments in the discovery of their biological functions are reviewed.

[Life style, Chlamydia trachomatis infection, bacterial vaginosis and their impact on the frequency of cervical lesions]. / Wplyw zakazenia Chlamydia trachomatis i Bacterial vaginosis oraz stylu zycia na wystepowanie zmian szyjki macicy.

OBJECTIVES: Sexually transmitted infectious factors attained unquestionable importance in the initiation of the cervical intraepithelial neoplasia. The aim of this study was to evaluate the incidence and impact of Bacterial vaginosis, Chlamydia trachomatis infection in accordance to a life style on clinically and cytologically evaluated cervical lesions. DESIGN/METHODS: Seventy-two young women without any symptoms were included to the study. Women underwent pelvic examination when cervical smears for cytology and Ch.tr. were taken and BV tests were performed. Presence of Chlamydia was estimated by direct immunofluorescent method. Subjects included to the study provided information concerning life style, and gynecological complaints. RESULTS: In both BV(+) or Ch.tr.(+) women, abnormal PapTest results were more frequently observed. All those three factors correlated with declared over 5 lifetime sexual partners. Ch.tr. infection correlated with BC pills using, cigarette smoking and presence of the cervical lesions evaluated as glandular ectopy. Abnormal PapTest result was obtained in 12 subjects. Two, the most abnormal cases were described as LSIL and confirmed by direct biopsy as CIN 1, also with coexistence of C. trachomatis infection and positive for BV. CONCLUSIONS: Ch.tr. infection seems to affect more frequently sexually active, smoking, young women using BC pills, with presence of cervical lesion described as clinically unsuspected glandular ectopy, although with occasionally cytological abnormal findings.

[Human papillomavirus -- the major infectious factor in the process of cervical intraepithelial neoplasia]. / Zakazenie wirusem brodawczaka czlowieka -- glówny czynnik infekcyjny w transformacji nowotworowej nablonka szyjki macicy.

In spite of increasing knowledge concerning cervical cancer; and the documented role of Human Papilloma Virus (HPV) -- as a major causing factor; there have been no changes in the epidemiological situation of this disease, especially in our country. Cytological screening has made crucial impact on decreasing mortality in that carcinoma. HPV involvement in cervical neoplasia and new diagnostic methods give possibility for early diagnosis of cervical lesions and to identify the group of women with higher risk of cervical cancer. Nevertheless there are no strict recommendations concerning HPV diagnostic procedures especially in the mass screening programmes. Therapeutic methods, specifically for HPV infection are still unknown. Based on the above, questions arise, if it is medically and financially justifiable to detect HPV infection? What is the clinical algorithm for the management of infected patient? And what is the future treatment?

[Computerized fluorocolposcopy--the significance in evaluation and therapy of early cervical lesions]. / Skomputeryzowane badanie fluorokolposkopowe--rola w ocenie oraz w terapii wczesnych zmian szyjki macicy.

Understanding of cervical cancer biology has made it was possible to determine intraepithelial lesions in the early stage of carcinogenesis.The aim of the study was to design the computer model of colour analysis of fluorocolposcopic pictures, based on biology evaluation of early epithelial cervical lesions. From the other hand increasing non-radical treatment efficacy by the precise visualisation of the biopsy place and borderlines of therapeutic tissue destruction, using digital model of colours analysis. All colours typical of Berthalanffy technique were characterised by 3D mathematical, digital model in the range of primary colours (R-red; G-green; B-blue) and Munsell System components (H-hue; S-saturation; l-intensity). Digital model of colour analysis of fluorocolposcopy images lets precise evaluations of early epithelial cervical lesions. Computerised fluorocolposcopy seems to be an examination with higher diagnostic accuracy (sensitivity - 97.8%, specificity - 99.8%, k rate - 0.93). Mathematical model of digital colour analysis also lets very precise visualisation of the biopsy place and borderlines of therapeutic tissue destruction.

[Mass screening programs running in Podlaski region based on standards existing in European Union-- actual status and future perspectives]. / Masowe badania przesiewowe dzialajace w województwie podlaskim w oparciu o standardy funkcjonujace w Unii Europejskiej - stan obecny i perspektywy na przyszlosc.

High mortality rates caused by breast cancer and cervical cancer are still an actual and enormous problem in our country. Such unfavorable epidemiological situation lasts for many years, in spite of availability of diagnostic procedures, which permits secondary prevention of these diseases. Successes of mass screening programs conducted in several European Countries are the best proof for this statement. For the last years the number of mammography and cytology tests systematically have been been going up in our country, unfortunately without any effects on women's mortality rates. The question arises: what is the reason for that situation and if could it be useful to adopt European experiences into the Polish conditions? This could be done by appropriate staff training and increase of effectiveness of diagnostic and therapeutic procedures. One more core element of mass screening programs is logistic background--coordinating center ensuring good functioning of the screening program.

[The use of interactive medical data transfer to increase effectiveness of a mass screening program]. / Wykorzystanie srodków multimedialnego przekazu w zwiekszeniu efektywnosci prowadzonych programow profilaktycznych.

Cervical cancer is still called the most frequent neoplasm refer to women's genital tract (incidence rate 30-35/100,000/year). Scandinavian countries experiences have shown that effective screening program especially used multimedia (radio, TV, Internet) is one of the based elements, which should improve situation in prevention of cervical cancer. The aim of this study was an attempt to create medical Website including specialized and basic informations for doctors and patients about cervical and breast cancer, their prophylactic and treatment. An influence of these data to increase active participation in screening program was also analysed. Material covers a random sample of 1200 women (30-59 years of age) who were invited to participate in cytology screening in two edition of the program (1997-99, 2000-02). In the years of 2000-02 information about Website was added to the invitation. Medical Website was created as server information. A special questionnaire prepared by Sociology Department was distributed to 1200 women. In both group participation during two screening edition was compared and analysed. All data were statistically correlated. Website address was created: http://pkzr.ac.bialystok.pl. From the group of 1200 questioned (mean age--41.8) answered 1059 women (88.25%). 6.98% (n=74) have never used this Website but 20 of them have done cytology test after receiving an invitation which were posted to all 1200 women. The last of 985 women analysed Website. 80.4% (n=792) have received enough informations about cervical and breast cancer (4.67 point) and decided to participate in cervical cancer screening. From this group only 428 women actively took part in cytology exams in 1997-99. 189 women participated in the screening programme from the last 193 patients (19.6%) who analysed server informations (4.89 point). From 141 people who have not answered for the questionnaire 23 have done cytology test. Participation in the second edition of cervical cancer screening programme (1997-99) was 41.9%. It was really two times lower than in the same group who could used Internet and was estimated on 85.3%. Internet site--http://pkzr.ac.bialystok.pl seems to be a basic digital textbook about cervical and breast neoplastic disease and their prophylactic. It is also interactive transferring data source that could create healthy attitude to increase effectiveness of screening programmes.

[Human papilloma virus (HPV) infection in the pathology of the endometrium. Role of immunological activation in antiviral and antineoplastic defense]. / Infekcja human papilloma virus (HPV) W zmianach patologicznych blony sluzowej trzonu macicy. Rola aktywacji ukladu immunologicznego w obronie przeciwwirusowej i przeciwnowotworowej.

Endometrial cancer is one of the most prevalent neoplastic diseases in women, in the developed countries. In spite of hormonal dysfunction, no pivotal mechanism leading to this pathology is known. The study design was to evaluate the presence of human papilloma virus within the endometrium by in situ hybridization and its potential role in the occurrence of dysplastic and neoplastic endometrial lesions. Immunological antiviral and antitumour defense was investigated by cytometric measurement of selected lymphocyte subsets. Viral infection was present in nearly 25% of endometrial cancer patients and occasionally within endometrial hyperplasia with cellular atypia. The presence of human papilloma virus correlated with significant depletion of CD4 lymphocytes as well as activated T cells and NK.

[Microwave thermography in the assessment of breast pathology]. / Termografia mikrofalowa w ocenie zmian guczolu sutkowego.

Searching for a noninvasive method of the diagnosis of breast pathology was the initial reason of setting up this study. The aim of this work was to answer the following questions: does the microwave thermography allow us to detect pathological masses within the breast and may it be used as the screening test taking under consideration its diagnostic accuracy. The results of microwave thermography were compared with physical examination, ultrasonomammography, mammography, cytology (from aspirating biopsy - BAC) or histopathological examination (performed during operation or as open diagnostic biopsy). Statistically significant differences in temperatures obtained by thermography, were revealed between three groups (healthy control, women with benign breast disease and group of patients with breast cancer), for the temperature amplitude within whole breast tissue. Statistical significance was also obtained comparing temperature amplitude examined beyond palpable breast mass. There was no statistical significant differences between tumour volume, clinical stage of disease, morphological differentiation of breast disorders and examined differences of the values of temperature amplitude. The usefulness of microwave thermography in the detection of breast disorders (both breast carcinoma and benign breast masses), gives hope for final success in searching for noninvasive diagnostic procedures, which can be implemented as a screening examination of women population.