Secreted phosphoprotein-1 directly provokes vascular leakage to foster malignant pleural effusion.

Secreted phosphoprotein-1 (SPP1) promotes cancer cell survival and regulates tumor-associated angiogenesis and inflammation, both central to the pathogenesis of malignant pleural effusion (MPE). Here, we examined the impact of tumor- and host-derived SPP1 in MPE formation and explored the mechanisms by which the cytokine exerts its effects. We used a syngeneic murine model of lung adenocarcinoma-induced MPE. To dissect the effects of tumor- versus host-derived SPP1, we intrapleurally injected wild-type and SPP1-knockout C57/BL/6 mice with either wild-type or SPP1-deficient syngeneic lung cancer cells. We demonstrated that both tumor- and host-derived SPP1 promoted pleural fluid accumulation and tumor dissemination in a synergistic manner (P<0.001). SPP1 of host origin elicited macrophage recruitment into the cancer-affected pleural cavity and boosted tumor angiogenesis, whereas tumor-derived SPP1 curtailed cancer cell apoptosis in vivo. Moreover, the cytokine directly promoted vascular hyper-permeability independently of vascular endothelial growth factor. In addition, SPP1 of tumor and host origin differentially affected the expression of proinflammatory and angiogenic mediators in the tumor microenvironment. These results suggest that SPP1 of tumor and host origin impact distinct aspects of MPE pathobiology to synergistically promote pleural fluid formation and pleural tumor progression. SPP1 may present an attractive target of therapeutic interventions for patients with MPE.

In-hospital mortality in a tertiary referral hospital: causes of death and comparison between patients with and without diabetes.

INTRODUCTION: Subjects with type 2 diabetes mellitus (T2DM) have increased morbidity and mortality mainly due to macrovascular complications. In addition, diabetic patients show increased in-hospital admissions in comparison with nondiabetic patients. However, in-hospital mortality data for patients with T2DM are not available in our country. The aim of the present study was to examine mortality rates in diabetic compared to nondiabetic patients admitted to a tertiary hospital during a 10-year period (1998-2007). MATERIAL AND METHODS: We performed a retrospective analysis of mortality rates in patients with and without T2DM hospitalised in a tertiary care hospital during the years 1998-2007. Demographic characteristics, medical history and outcome were collected from the patients' medical records. Patients with type 1 diabetes were excluded from the analysis. RESULTS: A total of 16 125 patients' records were studied (14 005 without diabetes and 2 120 with T2DM). In the total sample, 1 467 (9.1%) deaths were recorded. Mortality rates were higher in the diabetic than in the nondiabetic patients (11.2% versus 8.7%, respectively, p<0.001). Age of death did not differ between diabetic and nondiabetic patients (age+/-SD: 77.1+/-9.5 vs. 77.6+/-16.3 years, p=0.73). Median length of hospital stay was higher in the diabetic than in the nondiabetic patients (p=0.03). Mortality was higher in the diabetic in comparison with the nondiabetic females (59.9% vs. 52.7%, respectively, p=0.04), while no gender difference was found in males. Cerebrovascular disease was the commonest cause of death in both diabetic and nondiabetic patients (41.6% vs. 30.3%, p=0.001), followed by infections (23.1% vs. 21.7%, respectively, p=0.62). Death rates from malignancies were more common in the nondiabetic in comparison with the diabetic patients (18.8% vs. 4.2%, p<0.001). No significant differences were observed between the two study groups regarding mortality caused by cardiovascular events and chronic renal failure. CONCLUSION: The present study showed that diabetic patients and especially females had increased in-hospital mortality compared with nondiabetic patients. Cerebrovascular disease and infections were the more common cause of death in both groups.

Errors in death certificates in a rural area of Greece.

INTRODUCTION: A death certificate is the formal document in which a physician records the time, cause and circumstances under which the death of an individual has occurred. Morbidity and mortality statistics are mainly based on the analysis of these certificates, and inaccuracies in the detail may lead to biased estimation in several epidemiological parameters. The aim of this study was to examine the quality of cause of death in death certificates in a rural area of Greece, and to identify factors that may be associated with inaccuracies in the completion of these death certificates. METHODS: All death certificates archived in the municipality of Tritaia during the period 1999-2006 were examined. Statistical analysis was performed by comparing the proportions of the unpaired case. The state of independence among the various variables was investigated by considering the class of discrete graphical models. RESULTS: In total, 516 death certificates were examined; 5.6% (29/516) were excluded because of insufficient demographic data. The remaining 487 death certificates were analyzed with the following findings: 51.5% were for males and 48.5% females (median age 82 years, range 5-103 years; and 83 years, range 0-104, respectively); and 39.4% (192/487) were correctly completed. In 168 the mechanism of death was given; in 72 multiple causal sequences were given; in 22 a single/not precise cause was given; and in 33 a single causal sequence with incorrect order was given. In all, 20.1% were completed by a physician of the regional health centre. Gender was not associated with the presence of error (p = 0.352). Errors were present in 63.8% (270/423) of the death certificates in deceased individuals > or =60 years and in 39.1% (25/64) of the death certificates in individuals < or =59 years (p<0.001). In 19.7% of the erroneously completed death certificates, the certifier was a physician working in primary health care. The presence of errors in death certificates decreased from 74.6% in 1999 to 51.8% in 2006 (p = 0.004). CONCLUSIONS: Giving the mechanism instead of the cause of death was the most frequent type of error. A statistically significant increase in the presence of errors was observed as the age of the descendent increased. During these 8 years, there has been a statistically significant decrease in errors. However, efforts should be made by trainers and physicians in order to improve the accuracy of the information in death certificates. If this is accomplished, cause-of-death statistics will be more accurate and so enable better health planning.

Plasma retinol and tocopherol levels in greek elderly population from an urban and a rural area: associations with the dietary habits.

Data on plasma concentrations of retinol and alpha-tocopherol in elderly (over 65 years) living in the Mediterranean countries are sparse. In the current study, plasma retinol and alpha-tocopherol concentrations were determined in 200 healthy subjects (82 men and 112 women) residing in an urban and in a rural area in South Western Greece. High prevalence of low plasma retinol concentration was observed for both sexes in each area. The 16.7% of males in urban and 25.4% in rural area had plasma retinol levels below 0.3 mg/l. The corresponding values for female subjects were 26% and 20.3%. Plasma alpha-tocopherol was found to be within normal range in the rural area (only one male had plasma alpha-tocopherol below 5 mg/l) while in the urban area 68.3% of men and 62% of women had plasma alpha-tocopherol values below 5 mg/l. Differences in dietary habits between subjects living in the rural and in the urban area were revealed through a weekly food frequency questionnaire. This could partly explain the difference in alpha-tocopherol concentrations between the two areas. The results of this study revealed high risk of vitamin A and E deficiency and suggests that the health care system in Greece should pay more attention on the social and health status of its elderly population.

Correlation between serum IL-6 and CRP levels and severity of head injury in children.

OBJECTIVE: To examine interleukin-6 (IL-6) and C-reactive protein (CRP) release in children with head injury (HI) and investigate if there is a correlation between the levels of these two proteins and the severity of HI. DESIGN: Prospective clinical investigation. SETTING: Eight-bed paediatric intensive care unit in a university hospital. PATIENTS: Forty-five children were followed up for 4 days after HI and their serum IL-6 and CRP levels were measured. MEASUREMENTS AND RESULTS: Peak serum IL-6 levels occurred 4 h postinjury, decreasing over time. CRP was normal 4 h after injury, then increased reaching peak levels in 48 h. Children with admission Glasgow Coma Scale (GCS) scores of 8 or less had higher IL-6 levels compared to children with GCS scores higher than 8, 4 and 12 h post-injury (p<0.01 and p<0.05, respectively). IL-6 was higher in children with admission PRISM scores of 10 or more than in those with PRISM scores lower than 10 at 4 and 12 h (p<0.05). CRP levels were higher in patients with GCS scores of 8 or less compared to patients with GCS scores higher than 8 at 24, 48 and 72 h (p<0.05, p<0.02 and p<0.02, respectively) . Patients with PRISM scores of 10 or more had higher CRP levels compared to those with PRISM scores lower than 10 at 24, 48 and 72 h (p<0.05). Peak CRP levels correlated well with peak IL-6 levels (r = 0.49, p<0.001). No correlation between IL-6 or CRP levels and mortality or clinical outcome was found. CONCLUSIONS: Serum IL-6 and CRP levels are elevated in children with HI and there is a relation between the severity of HI and the levels of these proteins. There was no correlation between IL-6, CRP and outcomes of the patients.

Reported influenza in pregnancy and childhood tumour.

The present study was conducted to test the hypothesis that exposure to influenza in pregnancy increases the risk of tumour of certain type in childhood. Children ages 17 years or less diagnosed in Greece with brain tumours or neuroblastomas from 1982 to 1993 (n = 94) were contrasted to 210 controls selected from the same hospitals. Mothers of these children were interviewed about a variety of possible etiologic factors. The prevalence of influenza in Greece for each year during the period 1984-1992 was also compared with the number of children born during the same year who subsequently developed brain tumour or neuroblastoma. The results indicate a significant association between influenza in pregnant women and occurrence of tumour in index child (OR: 3.15, 95% CI: 1.13-8.77). These results persisted when adjustment for potential confounding factors was made. The findings should be interpreted cautiously because of lack of serologic documentation of information about infection obtained in interviews. A positive correlation (r = 0.74) of the number of tumour births by year of birth with the prevalence of influenza during the same year was also noted. This exploratory study is one of the few case-control studies of the epidemiology of childhood tumours in children, and the results suggest directions for future epidemiologic studies in this relatively uncharted field.

Road traffic accidents in Greece: recent trends (1981-1991).

This study describes trends of road traffic accidents (RTAs) in Greece over the past 11-year period. All casualties that occurred in Greece during the period 1981-1991 are analyzed. Trends in severity (as judged by the proportion of fatal or serious casualties) are studied. The rate 'casualty per registered vehicle' is also used and is mainly based on the number of road users killed or seriously injured. The total number of deaths presents a considerable increase by about 32%, but an important reduction of serious injuries was observed during the same period. The number of fatal injuries increased significantly only in drivers whereas no such increase is observed in passengers and pedestrians. In all three categories of road users, serious injuries decreased significantly with a similar linear regression slope. RTAs in Greece are also becoming less severe in all categories of road users. Accidents per registered vehicle decrease significantly in all road user groups and age groups. The slope of this decrease is rather exponential, suggestion that any further increase of the number of registered vehicles will be followed by a similar increase of the number of casualties so that the rate will tend to remain stable. This represents a very challenging situation of how to keep the number of casualties as low - or, at least, as stable - as possible despite high vehicle densities. There is uncertainty about the factors that led to the observed decreases, as it was difficult to single out effects of specific measures, because of data limitations. An improved data collection system is necessary in order to enable a more thorough analysis of casualty trends not fully addressed in this study.

Establishing baseline data in cancer registration in northern England: implications for Health of the Nation targets.

OBJECTIVE: To assess the completeness and accuracy of cancer surveillance data relevant to Health of the Nation targets. DESIGN: A comparison of locally ascertained data on cancer with recorded cancer registry sources in selected diagnoses. SETTING: The district of South West Durham within the Northern Regional Health Authority. PATIENTS: All patients with lung, skin, and malignant cervical cancer who were resident and diagnosed in the district or identified in the Northern Region Cancer Registry during the calendar period 1989-91. MAIN RESULTS: Of 544 cases of cancer identified from all available sources, 448 (95.8%) were registered, ranging from 93.9% for malignant cervical cancer to 96.7% for skin cancer. In 448 cases which were both identified locally and registered, 53 (11.8%) showed disagreements between local sources and register data, involving classification of site and timing of registration. Twenty three cases were identified locally but were not registered, 22 registered but not identified locally, and 51 registered with the casenotes missing locally. CONCLUSIONS: Any real achievement of Health of the Nation targets may be masked by changes over time in the accuracy and completeness of information systems. In assessing the achievement or otherwise of targets, it is important to be aware of any differences in the completeness and accuracy of the baseline data compared to future measurements.

Autotransfusion after coronary artery bypass surgery: is there any benefit?

Postoperative salvage autotransfusion of shed mediastinal blood, using the cardiotomy reservoir, is an inexpensive technique whose efficacy and safety are evaluated in this study. We randomized 75 consecutive patients into two groups. The autotransfusion group (n = 42) received autotransfusion after the completion of the coronary artery bypass grafting (CABG) until the drainage was < or = 50 mL per hour for 2 consecutive hours. The control group (n = 33) was treated with standard chest drainage. Both groups received homologous blood transfusion when the hematocrit fell below 30%. Packed red cells were required post-operatively in 84.8% of the control group and 80.9% of the autotransfusion group (p = NS). Postoperative colloid fluid replacement (excluding autotransfusion fluid) did not differ significantly between the groups. The prothrombin time was significantly higher in the autotransfusion group 24 hours postoperatively (p = 0.03). The fibrin degradation products were elevated only in the serum of the autotransfusion patients (p < 0.002). More febrile patients were seen in the autotransfusion group although not significantly more than the controls. The autotransfusion group received more red cells than the control group, but it lost more red cells in the mediastinal drains. In conclusion, the autotransfusion of shed mediastinal blood has not proved beneficial in reducing the postoperative requirements in homologous blood in patients undergoing coronary artery bypass grafting (CABG).