The role of the NY-ESO-1 in the prognosis of gastric cancer.

Gastric cancer is one of the most common malignancies worldwide and the fourth leading cause of cancer-related deaths. Gastric cancer is a multifactorial disease influenced by both environmental and genetic factors. Its most critical features include invasiveness and high metastatic potential. Metastasis is a complex process, and our understanding of the mechanisms involved remains incomplete. Growing evidence suggests that cancer-testis antigens (CTAs) play a crucial role in the metastatic potential of various tumors. Several studies have linked CTA expression with lower tumor differentiation, higher metastatic potential, and poor chemotherapy response. New York esophageal squamous cell carcinoma 1 (NY-ESO-1) antigen, part of the CTA group, is expressed in tumor tissues, while its expression in normal tissues is restricted to spermatogonia. This study aimed to determine the expression of NY-ESO-1 in primary adenocarcinoma of the stomach, both with and without metastasis in regional lymph nodes, and to compare it with TNM stage, age, gender, and survival. We analyzed gastric cancer tissue from 53 node-negative and 55 node-positive primary gastric carcinoma patients for NY-ESO-1 expression using immunohistochemical assay. The results were correlated with clinicopathological parameters and survival. Patients with positive NY-ESO-1 expression in primary tumors had a median survival of 19.0 months (range 14.1 - 24.0), in contrast to those with negative expression, who had a median survival of 52.0 months (range 0.0 - 133.3) (chi-square 7.99, P = 0.005). T status, N status, and NY-ESO-1 expression were all independently associated with shorter survival. No significant difference in NY-ESO-1 expression in primary tumors was observed concerning lymph node metastasis status. In summary, our findings suggest that increased expression of NY-ESO-1 could potentially serve as a prognostic biomarker for gastric cancer.

(Dis)organization of Palliative Care as a Potential Quality-of-Life Issue in the Senior Population--Croatian Experiences.

This paper analyses the current situation in the Croatian health-care system, with special emphasis on the (dis)organization of palliative care within the public health, more precisely gerontology context. Namely, population world-wide is getting older, that is both a statistical and an everyday-medical fact. Today we consider citizens after the age of 65 as the elderly, with a tendency to move the age-limit to 75 years. Croatia on the matter swiftly follows global trends, while literature points to the fact that an increase in the elderly population dictates the need for an organized system of palliative care and hospice building. Although we cannot ignore the fact that children can become palliative care patients, we can conclude that these are predominantly elderly patients. In fact, approximately half of patients--users of palliative care--have some type of oncological diagnosis; a significant number of patients suffer from dementia, stroke, or heart failure. As for the Primorsko-goranska county and the City of Rijeka, they show similar trend, as can be illustrated with data from the 2011 census, when the share of citizens over 65 years in the population of the Primorsko-goranska county reached 18.91%, and in the population of the City of Rijeka 19.74%. Thus, one of the main quality-of-life issues in the Croatian senior population is the (dis)function of the palliative medicine/care system. Practice, namely, shows that there has still been no implementation. In particular, palliative medicine is not yet recognized as a speciality or sub-speciality, standards and norms for this activity are not set, palliative care is still not included in the system of obligatory health insurance, and as far as the national strategy of health policy for the area of palliative care, Croatian Government at its meeting held on 27th December 2013 finally adopted the "Strategic Plan for Palliative Care of the Republic of Croatia for the period from 2014 to 2016". Exactly because we are a decade behind European standards (Recommendation Rec (2003) 24 of the Committee of Ministers to member states on the organization of palliative care), it is more than legitimate to place this subject at the centre of the current Croatian gerontology interest.

Combined use of clips and nylon snare ("tulip-bundle") as a rescue endoscopic bleeding control in a mallory-weiss syndrome.

Mallory-Weiss syndrome (MWS) accounts for 6-14% of all cases of upper gastrointestinal bleeding. Prognosis of patients with MWS is generally good, with a benign course and rare recurrence of bleeding. However, no strict recommendations exist in regard to the mode of action after a failure of primary endoscopic hemostasis. We report a case of an 83-year-old male with MWS and rebleeding after the initial endoscopic treatment with epinephrine and clips. The final endoscopic control of bleeding was achieved by a combined application of clips and a nylon snare in a "tulip-bundle" fashion. The patient had an uneventful postprocedural clinical course and was discharged from the hospital five days later. To the best of our knowledge, this is the first case report showing the "tulip-bundle" technique as a rescue endoscopic bleeding control in the esophagus.

Dental caries experience in Croatian school children in Primorsko-Goranska county.

BACKGROUND: Dental caries as an infectious disease is still a major oral public health issue. As documented in some recent studies, it has been recognized as the most common chronic childhood disease. AIM: The aim of this study was to evaluate caries prevalence, DMFT and dmft scores, as opposed to caries free children at the age of 6 years from a well developed western region of Primorsko-Goranska county. The purpose was also to evaluate a Significant Caries Index (SiC) and a Restoration Index (RI) in the same study sample of 6 year olds. METHODS: Data for a sample of 1,825 (868 girls and 957 boys) children was collected and analyzed by using Chi-square and Mann-Whitney U Tests. RESULTS: Results showed that the mean dmft was 4.68 +/- 4.19, and the mean DMFT was 0.22 +/- 0.69. D/d component constituted a major part of caries score (DMFT/dmft) in both primary and permanent dentitions in the population of 6 years old children. Caries prevalence was 74.5 in primary dentition and 11.9 in permanent dentition. Significant Caries Index value (SiC) was 0.66 for permanent and 9.6 for primary teeth, respectively. The Restoration Index (RI) was 20.1 for primary and 39.5 for permanent dentition. CONCLUSION: The results obtained in this study revealed that dental caries still appears to be quite a significant problem among 6 year olds. However, collected data, particularly considering the SiC Index, can be used for further planning of preventive and restorative dental treatments as well as setting up future goals for the prevention of dental caries in Croatian school children of Primorsko-Goranska county.

Parents' attitudes on sexual education--what and when?

This study aims to detect opinions about what and when should be talked about in sexual education in schools respecting the role of parents. This study was conducted in 23 elementary schools in the town Rijeka, Croatia from March to May 2010. The sample consisted of parents of sixth grade elementary school pupils. There were 1,673 respondents, divided in groups of mothers and fathers. Both groups had answered what is the majority of topics to be talked about in the higher grades of elementary school. In lower elementary school grades children should be taught about the structure and differences of male and female genitalia. Topics that most parents find inappropriate to be talked about in sexual education, are sexual satisfaction and pleasure, masturbation, pornography and prostitution (5.01-7.7%). Results of this study can help in creating sexual education programs in schools where parents are considered of being equal accomplices.

Implementation of program of prevention and early detection of osteoporosis among women of Primorsko-goranska County.

The aim of this paper is to present preliminary data of Program of prevention and early detection of osteoporosis among women in Primorsko-goranska County. Osteoporosis is recognized as a public health problem for which clearly preventive measures are defined. Measurement of bone density was done by ultrasound densitometry of the calcaneus among women aged from 45 to 69 years old. 688 women were examined and they were classified in five five-year age groups. The women with the osteoporosis (T-score < or = 2.5) were 141; osteopenia (T-score from -2.5 to -1) were found in 400 women, and those with normal range of T-score were 147. All of five groups of women had T-score in range of osteopenia (T-score < or = 1). A statistically significant difference was between the first and fourth groups of women (p = 0.002) and the second and fourth groups (p = 0.001). After examination, depending on the value of T-score, women were recommended to visit family doctor and they also got educative booklet with advices for healthy nutrition and physical activity. Implementation of this program indicated the importance of proper lifestyle in the prevention of osteoporosis. Average T-scores of all five groups of women show that osteopenia occurs also in the youngest ones. This indicates the need for a systematic approach to preventing osteoporosis through education of women including younger ones and creating conditions for organized physical activities at the community level.

Increasing burden of melanoma in Croatia.

Melanoma consists 4-5% of all skin cancers, but it contributes to 71-80% of skin cancers deaths. It is controversial whether worldwide increases in melanoma incidence represent a true epidemic but at the same time that dramatic increase in incidence occur in setting of relatively stable mortality trends, observed in Croatia also. The majority of authors accept that main risk factors for melanoma relate to environmental exposure and genetics with epidemiologic studies linking sun exposure to melanoma development. Data were obtained from Croatian cancer register for patients diagnosed between 1999 and 2008, for malignant melanoma of the skin (ICD-10 code C43) at national level and from 2003 to 2008, at the County level (Primorsko-goranska County). Melanoma incidence nearly doubled in males from 8.75 to 13.4/10(5) per year, fold in females from 9.1 at the start of observation to the end of 12.0/10(5) per year in Croatia. Melanoma incidence rates were much more higher for Primorsko-goranska County with range from 10.1 to 17.5/10(5) per year. The greatest increase of melanoma incidence rates was in males 60 years and over year group at diagnosis. National comparison of variation in cancer incidence by region and age can provide basis for public health prevention. It requires the integration of information on risk factors, incidence that could help to reduce regional inequalities in incidence and reduce the future cancer incidence.

Cervical cancer screening programme in Primorsko-Goranska County, Croatia--the results of the pilot study.

The opportunistic cervical cancer screening has been conducted in Croatia since its introduction in the 1960s, in the context of a high quality gynaecological cytology with a long tradition and a wide network of primary care gynaecologists. In 2006, a pilot screening programme under the title "Early detection of cervical cancer was conducted in Primorsko-Goranska County (PGC)", as the first organised cervical cancer screening ever conducted in the Republic of Croatia. The pilot screening programme targeted women aged 20-64 years. The pilot group consisted of 6,000 randomly sampled primary care patients of six gynaecologists. The women were invited via a personal letter and were given a questionnaire. The results of the first and the second year of screening, as well as of both years together were analysed. The response rate to the anamnestic questionnaire was 49.1%. The participation rates to the screening were 35.2% in 2007, and 46.5% in 2008, total of 42.7%. The increase in participation between years 2007 and 2008 was statistically significant (p = 0.01). According to the age, the lowest participation rate of 33.3% was observed in the youngest group of women (20-29) and the highest of 60.7% in the oldest group (60-64). The detection rate of cytological abnormalities was 4.6% with 2.6% of borderline (ASCUS) cytology and referral rate of 1.2%. The highest abnormal Pap test frequencies of 6.8% and 7.1% were observed in the youngest age groups (20-29 and 30-39), and the lowest (2%) in the age group of 60-64. Specimen adequacy was generally of high quality with unsatisfactory rate of 0.8%, with statistically significant improvement in 2008, compared to the previous year (p = 0.001). Although to a limited extension, during two-year pilot cervical cancer screening programme in PGC the participation rates and Pap smear adequacy have improved. We expect that the continuation of the programme will result in further increase of participation and higher overall quality of the programme.

[Review of the program of early detection of cervical cancer in women in Primorsko-Goranska County in 2009]. / Rano otkrivanje raka vrata maternice u zena primorsko-goranske zupanije u 2009. Godini--prikaz programa.

INTRODUCTION: Cervical cancer is the most common cancer in women, the second most frequent malignancy in women and the second most common cause of death in women suffering from cancer worldwide. In 2009, in the Primorje-Goranska County 52 (4.1%) women were hospitalized for the treatment of cervical cancer. AIM: The aim of this paper is to show the methodology and results of the County program in 2009. METHODS: The County Institute of Public Health (IPH) has been conducting this screening program systematically since 2006. In 2009, screening was conducted at six gynecologic practices with coverage of 6000 women. Prior to Program performance, the IPH provide the gynecologists with all necessary logistics (brushes for cytobrush technique, Pap tests, addressed envelopes, invitation letters and patient questionnaires). The gynecologists include women by random choice, each gynecologist around 1000 women of the specified age group. They send invitations to women with specified date and time of testing. Swabs are referred to the Cytology Laboratory, Rijeka University Hospital Center in Rijeka. For the purpose of this Program, IPH has designed a questionnaire for women, containing 13 questions. Patients give the questionnaires back to the gynecologists, who send them to the IPH for statistical analysis. Data collected from the questionnaires and Pap test findings are entered in a specially designed computer program. During Program implementation, the IPH, gynecologists and cytologists work together to improve the quality of testing. For the purpose of education of women about sexual health and to improving the response rate, IPH has created and distributed 10,000 educational brochures entitled Sexual health of women, the knowledge is power. RESULTS: In 2009, the response rate in the Program was 41.9% (n=2514). Cytologic analysis of Pap tests yielded 94.5% of negative results and 5.1% of abnormal findings. Adequacy of 99.6% of Pap smears was satisfactory, while 0.4% of samples were of poor quality that could not be analyzed. Results showed 66.7% of women to undergo gynecologic examination once a year, whereas 17.9% of women had not been for gynecologic examination for more than 3 years. The majority (90.7%) of women that participated in the Program were visiting the chosen gynecologist at primary health care. DISCUSSION: Throughout the Program implementation, the leading problem continued to be low turnout of gynecologists for inclusion in the Program and poor turnout of invited women. The cause of this problem lies in the insufficient number of gynecologic teams and too many women in care of one gynecologist. This problem points to the need of restructuring of primary health care for women with emphasis on the number of health professionals. Results of the analysis of two questions in the questionnaire indicated inadequate knowledge of women about the importance of regular gynecologic control. When planning screening program in the coming years, attention should be focused on the motivation of women of younger age groups as well as those that are irregularly controlled. CONCLUSION: Organized screening can reduce the risk and mortality of cervical cancer. It is also known that with a relatively small investment but with better health care organization, the response of women can increase. Taking into account the threat posed by cervical cancer for women's health and social burden, the need of prevention strategies, primarily screening tests, is clear as a means for early detection of the problem and timely removal of abnormal cells.