Determinants of hypofibrinolysis in patients with digestive tract cancer

Introduction: Recently, we demonstrated that digestive tract cancer (DTC) is associated with reduced fibrin clot permeability and impaired fibrinolysis. Aim: We investigated determinants of fibrinolysis in DTC patients. Material and methods: In 44 consecutive patients with DTC and 47 controls matched for age, sex, and cardiovascular risk, we evaluated fibrinolysis proteins, platelet activation markers, thrombin formation, together with plasma clot lysis time assays in the absence (CLT) and presence of carboxypeptidase potato inhibitor (CLT CPI) that blocks thrombin activatable fibrinolysis inhibitor (TAFI). Results: In the DTC group CLT (by 22.3%) and CLT CPI (by 27.4%) were longer compared with controls. The DTC patients had higher plasma fibrinolysis inhibitors, plasminogen activator inhibitor 1 (PAI-1) (by 18.2%), TAFI activity (by 17.3%), and antigen (by 11.2%). The patients had markedly increased platelet markers - soluble CD40 ligand (by 338%) and P-selectin (by 97%), together with von Willebrand factor (vWF) antigen (by 61%). Thrombin-antithrombin complexes (TAT) (by 48.7%) and soluble thrombomodulin (sTM) (by 17.2%) were also increased in the DTC group (all p < 0.05). Patients with high-grade tumours (n = 26) compared with remainders (n = 18) had longer CLT, higher tissue-type plasminogen activator antigen, both TAFI antigen and activity levels, vWF, and sTM. Multiple regression analysis after adjustment for potential confounders showed that independent predictors of CLT in DTC patients were TAT, TAFI activity, and vWF. The only independent predictor of CLT CPI was TAT. Conclusions: Hypofibrinolysis in DTC patients is largely driven by enhanced thrombin generation, TAFI, and endothelial injur

Interdyscyplinarna opieka nad pacjentem z chorobą nowotworową

Praca recenzowana / peer-reviewed paperZ przyjemnością przekazujemy Państwu kolejny tom monografii Interdyscyplinarna opieka nad pacjentem z chorobą nowotworową, która powstała przy współpracy Polskiego Stowarzyszenia Pielęgniarek Onkologicznych z Wydziałem Zdrowia i Nauk Medycznych Krakowskiej Akademii im. Andrzeja Frycza Modrzewskiego. Problematyka przedstawiona w publikacji dotyczy wieloaspektowej opieki nad chorym na nowotwór. Opracowania są doniesieniami z badań naukowych, w których autorzy przedstawiają wnioski i kierunki działań dla praktyków. Równie dużą wartość mają rozdziały, w których praktycy dzielą się swoją wiedzą i doświadczeniem z pracy z chorymi i ich rodzinami. Tematyka monografi i dotyczy m.in.: edukacji zdrowotnej, komunikowania się, opieki nad chorym poddawanym chemioterapii, leczeniu chirurgicznemu, radioterapii i rehabilitacji. Pragniemy, aby ta książka swoją merytoryczną zawartością stała się istotnym wkładem w uczczenie tak ważnych dla pielęgniarstwa rocznic, obchodzonych w 2011 r

The IDENTIFY study: the investigation and detection of urological neoplasia in patients referred with suspected urinary tract cancer - a multicentre observational study

Objective To evaluate the contemporary prevalence of urinary tract cancer (bladder cancer, upper tract urothelial cancer [UTUC] and renal cancer) in patients referred to secondary care with haematuria, adjusted for established patient risk markers and geographical variation. Patients and Methods This was an international multicentre prospective observational study. We included patients aged ≥16 years, referred to secondary care with suspected urinary tract cancer. Patients with a known or previous urological malignancy were excluded. We estimated the prevalence of bladder cancer, UTUC, renal cancer and prostate cancer; stratified by age, type of haematuria, sex, and smoking. We used a multivariable mixed-effects logistic regression to adjust cancer prevalence for age, type of haematuria, sex, smoking, hospitals, and countries. Results Of the 11 059 patients assessed for eligibility, 10 896 were included from 110 hospitals across 26 countries. The overall adjusted cancer prevalence (n = 2257) was 28.2% (95% confidence interval [CI] 22.3–34.1), bladder cancer (n = 1951) 24.7% (95% CI 19.1–30.2), UTUC (n = 128) 1.14% (95% CI 0.77–1.52), renal cancer (n = 107) 1.05% (95% CI 0.80–1.29), and prostate cancer (n = 124) 1.75% (95% CI 1.32–2.18). The odds ratios for patient risk markers in the model for all cancers were: age 1.04 (95% CI 1.03–1.05; P < 0.001), visible haematuria 3.47 (95% CI 2.90–4.15; P < 0.001), male sex 1.30 (95% CI 1.14–1.50; P < 0.001), and smoking 2.70 (95% CI 2.30–3.18; P < 0.001). Conclusions A better understanding of cancer prevalence across an international population is required to inform clinical guidelines. We are the first to report urinary tract cancer prevalence across an international population in patients referred to secondary care, adjusted for patient risk markers and geographical variation. Bladder cancer was the most prevalent disease. Visible haematuria was the strongest predictor for urinary tract cancer