Expressão imuno-histoquímica das proteínas E-Caderina e BCL2 e nevos melanociticos orais e cutâneos

Melanocytic nevi (MNs) are benign melanocytic proliferations of cells, which can be found in the skin and mucous coat, including the oral mucosa. However, skin NMs are more common when compared to those that affect the oral mucosa. The molecular mechanisms involved in the development of nevi and the factors that can influence the migration pattern of the nevus cells are little explored. The aim of this study was to analyze the immunohistochemical expression of E-cadherin protein and Bcl-2 in oral / skin NMs and relate them to the clinical characteristics (gender, age, location, exposure to solar radiation) and histopathological types. 36 cases of oral NMs and 34 Skin NMs were analyzed. The immunohistochemistry was used of the protein E-cadherin and bcl-2, which were analyzed the intensity (weak, moderate and strong) and distribution marking (diffuse and focal). The immunoreactivity also analyzed as to the types of nevus cells (epithelioid cells -A, -B lymphocyte and fibroblast-like -C). Statistical analysis was performed using the chi-square tests of Pearson and Spearman correlation with significance level set at 5%. Of the 70 cases of NMs, 82.9% were female, 48.6% aged 26-50 years, 51.4% were diagnosed histologically as intradermal / intramucosal nevi and 80% were NMs acquired. Immunohistochemical expression of BCL2 and E-cadherin were variables in the sample and showed no association with clinical parameters. The expression of bcl-2 and E-cadherin were variable according to the types of nevus cells (A, B and C) (P = 0.001). The expression of bcl-2 was more diffuse in congenital MNs (p = 0.002). E-cadherin was positive in 83.3% of MNs <1cm (p = 0.001) and exhibited weak staining in 73.9% of MNs that were in exposed areas (p = 0.010). Based on these results, it is suggested that the E-cadherin has a modulating effect on the migratory properties of NMs, and bcl-2 is a marker of MNs with increased proliferative capacity.

Tratamento Endovascular de Patologia da Aorta Torácica: Experiência Institucional

Introdução: O tratamento endovascular da aorta torácica (TEVAR) é uma modalidade terapêutica emergente que tem vindo a revolucionar a abordagem de diferentes tipos de patologia da aorta na sua localização torácica. Objetivos: Avaliação da experiência institucional do serviço de angiologia e cirurgia vascular. Métodos: Análise retrospetiva da série consecutiva de todos os doentes com patologia da aorta torácica e/ou toracoabdominal submetidos a TEVAR na nossa instituição. Foram excluídos aqueles com uso concomitante de endopróteses fenestradas/ramificadas abdominais. Resultados: Desde abril de 2005 até abril de 2014, 79 doentes foram submetidos a TEVAR, com idade média de 66 ± 12,83 anos (máx: 86; mín: 14). As indicações incluíram: 46 aneurismas (58%), 17 dissecções aórticas clássicas tipo B (22%), 13 no contexto de outras síndromes aórticas agudas (16%), 2 por ateroembolismo (3%) e um por fístula aortoesofágica (1%). Na patologia aneurismática, a distribuição anatómica da doença foi a seguinte: 5 na aorta ascendente e arco aórtico (11%), 35 na aorta torácica descendente (76%) e 6 toracoabdominal (13%). O diâmetro médio das dilatações aneurimáticas foi de 69,64 mm (máx: 150 mm). A rotura foi uma apresentação da patologia em 21,5% dos doentes (n = 17); 20,9% dos doentes tinham antecedentes de cirurgia aórtica prévia. A dissecção aórtica tipo B complicada foi a segunda indicação mais comum, sendo de apresentação aguda em 13 (76%) e crónica em 4 (24%). As complicações na base da intervenção foram dilatação aneurismática em 35% (n = 6), malperfusão com isquemia de órgão alvo 47% (n = 8), desconhecida em 18% (n = 3). Foi realizada extensão distal com stent descoberto (Petticoat) em 9 casos (41,2%) e foram realizados procedimentos adjuvantes em 18% (stenting renal n = 2; stenting ilíaco n = 1). Dentro das outras síndromes aórticas agudas, o TEVAR foi realizado no contexto de úlcera aórtica penetrante (n = 4), hematoma intramural (n = 4) e os restantes por rotura/pseudoaneurisma (n = 5). As endopróteses utilizadas foram: 32 Valiant Medtronic®, 15 TAG Gore®, 25 Zenith TX2 Cook®, 2 Zenith TX1 Cook®, uma Relay Plus®, 3 Talent Medtronic® e outras em 1%. A mediana de dias de cuidados intensivos foi 2 (intervalo 0-42) e a mediana de suporte tranfusional foi de 2 UCE. A taxa de mortalidade aos 30 dias ou intra-hospital foi de 18% (n = 14). Atendendo ao timing da cirurgia, a taxa de mortalidade aferida nos casos electivos foi de 8% (4/50) e nos urgentes atinge os 35% (10/29). Intraoperatoriamente foram tratadas 7 complicações relacionadas com vaso de acesso membro, 2 casos de dissecção aórtica iatrogénica, um caso de trombose arterial inferior e um endoleak tipo IA. A taxa de reintervenções foi de 17%, com as seguintes indicações: 9 endoleaks, 2 isquemias mesentéricas e 2 fístulas aortoesofágicas. Conclusões: A série apresentada traduz uma experiência institucional favorável com resultados reprodutíveis e que o TEVAR é um procedimento seguro e eficaz para o tratamento de diferentes patologias da aorta torácica, quando comparado com o tratamento cirúrgico aberto.

Determinación de la eficacia de la profilaxis antibiótica en pacientes con heridas limpias y limpias contaminadas, servicio de cirugía general, Hospital Vicente Corral Moscoso Cuenca-Ecuador 2007: estudio a realizarse en patologia biliar, apendicular y herniaria

Determinar la prevalencia de infección del sitio de la herida quirúrgica y factores asociados en pacientes que acudieron al Centro Quirúrgico del hospital Vicente Corral Moscoso, de la ciudad de Cuenca, en el 2007-2008.Se realizó un estudio transversal; en un universo de 385 pacientes. Los datos se obtuvieron por entrevista directa y se analizaron con el software Excel y Epi-Info. Resultados. La prevalencia de infección del sitio de la herida quirúrgica fue del 10.6(IC 959.03-12.17). La mayoría fueron de sexo femenino; la edad varió entre los 16 y 87 años. La asociación entre infección del sitio de la herida quirúrgica con cirugía de emergencia proporcionó una p=0.019 (IC 95de la RP 1.10 - 3.99); con cirugía convencional p= 0.778 (IC 95de RP 0.61-1.95); con herida limpia p= 0.238 (IC 95de RP 0.10 - 1.55); con la utilización de cefazolina p= 0.023 (IC 95de la RP 0.09-0.94) y con el tiempo quirúrgico menos de una hora p= 0.000 (IC 95de RP 0.01-0.32). Conclusión, la prevalencia de infección del sitio de la herida quirúrgica fue del 10.6(IC 959.03-12.17). La cirugía de emergencia fue factor de riesgo para infección del sitio de la herida quirúrgica y la cefazolina, utilizado como antibiótico profiláctico, y el tiempo quirúrgico, menos de una hora, fueron factores de protección

Caso dermatológico

O nevo do tecido conjuntivo (NTC) é um hamartoma que pode estar associada a várias síndromes, como esclerose tube- rosa, síndrome de Buschke-Ollendorf ou síndrome de Proteus. Casos familiares de NTC têm sido relacionados com maior risco de patologia cardíaca. A apresentação clínica típica caracteriza-se pelo aparecimento de múltiplas placas cor de pele ou amareladas, confluentes no tronco e/ou nos membros, assintomáticas. São geralmente identificados na infância, sem predileção de género. O diagnóstico é confirmado por biopsia cutânea. Estudos adicionais podem ser necessários, de acordo com a presença de sinais ou sintomas sugestivos de uma doença subjacente.

Estatuto socioeconomico, saúde e patologia mental na adolescência

Dissertação de mestrado apresentada ao ISPA - Instituto Universitário

Patologia da vagina em ressonância magnética

A ressonância magnética é um método excelente e cada vez é mais indicado na avaliação de alterações da vagina, em virtude da sua capacidade de avaliação multiplanar e alto contraste tecidual. A RM é usada no estadiamento de tumores da vagina e detecção de recidivas. Também é útil na caracterização de malformações congénitas. Neste artigo descrevemos as características em ressonância magnética das diferentes patologias congénitas e adquiridas da vagina.

Patologia e clínica de equinos

O presente relatório é baseado no estágio curricular em clínica de equinos, realizado entre 1 de Setembro de 2015 e 29 de Fevereiro de 2016, com a orientação da Dra. Maria Teresa Félix da Cruz Falcão. É composto por três partes: casuística, monografia e apresentação de dois casos clínicos. A primeira parte descreve a casuística que se acompanhou durante o estágio, na área de patologia e clínica de equinos. A monografia aborda o tema de intoxicação por amitraz em equinos. A última parte consiste na descrição de dois casos clínicos de intoxicação por amitraz que foram acompanhados durante o estágio curricular; ABSTRACT: Externship report – Equine pathology and medicine The following report is based on my externship between the 1st of Setember of 2015 and the 29th of February of 2016, orientated by Dr. Maria Teresa Félix da Cruz Falcão in equine clinics. It is composed of three parts: casuistics, monography and the presentation of two clinical cases. The first part describes the casuistics that were encountered during the externship, in equine pathology and medicine. The monography discusses the theme of amitraz intoxication in horses. The last part is composed of a description and discussion of two clinical cases of amitraz intoxication, accompanied during the externship.

Na especificidade, a evidência do impacto das intervenções do enfermeiro especialista em enfermagem de reabilitação no doente com patologia respiratória crónica, no serviço de urgência

O presente estudo decorreu no serviço de urgência do Hospital do Espírito Santo de Évora – EPE, de Setembro de 2015 a Janeiro de 2016 e enquadra-se na área da prestação de cuidados especializados em enfermagem de reabilitação. É um estudo de caso, em que objeto de estudo é “A Intervenção do Enfermeiro Especialista em Enfermagem de Reabilitação no doente com Patologia Respiratória Crónica”. A abordagem metodológica é mista pois trata-se de um caso de estudo que não é puramente qualitativo. A utilização de metodologia quantitativa com indicadores quantitativos permitirá uma melhor compreensão e visão global do caso apresentado. Trata-se de um estudo de natureza descritiva, transversal e não experimental pois tem como objetivo a recolha de dados observáveis e quantificáveis, num determinado período de tempo e não o controlo de fenómenos. População alvo: todos os utentes com Patologia Respiratória Crónica internados no Serviço de Observação no período de tempo referido anteriormente. Amostra: 4 utentes com média de idades de 78,0 anos dos quais 75% eram do sexo masculino e 25% do sexo feminino. Foram implementadas intervenções de enfermagem de reabilitação, nomeadamente, reabilitação funcional respiratória e motora, que demonstraram ser eficazes tendo-se obtido saturações periféricas de O2 de 96%, em média. Estes resultados traduzem-se em ganhos ao nível da capacidade respiratória permitindo o desenvolvimento de atividades de vida diária normais. Também foi possível a manutenção e potenciação das capacidades de mobilidade nestes utentes com uma média etária elevada e com algumas limitações físicas e/ou cognitivas o que, só por si, também traduz ganhos em saúde no que concerne à sua independência e melhoria da qualidade de vida. O Enfermeiro Especialista em Enfermagem de Reabilitação é claramente uma mais-valia no serviço de urgência pois ao colocar em prática uma dinâmica de desempenho voltado para os conhecimentos especializados adquiridos, criando ferramentas que permitam um desempenho estruturado dos cuidados, a promoção da sua continuidade, a sua avaliação e a produção de conhecimento científico baseado na evidência contribui para a redução do tempo de internamento o que se repercute na maior eficácia na Gestão de Unidades de Saúde.

Vazio e o buraco negro na patologia limite – Um contributo da/para a técnica Rorschach

Dissertação de Mestrado apresentada ao Instituto Superior de Psicologia Aplicada para obtenção de grau de Mestre na especialidade de Psicologia Clínica.

Efeito da massagem terapêutica na saúde mental das pessoas com patologia oncológica

CONTEXTO: O enfermeiro deve interagir com as pessoas em situação de saúde ou doença, melhorando o seu contexto sociocultural e o seu processo transição. Estas interações são organizadas com um propósito em que o enfermeiro utiliza ações terapêuticas para promover a saúde. A massagem terapêutica consiste em pressionar e esfregar o corpo ou partes deste com fins terapêuticos. OBJETIVO(S): Avaliar o efeito da intervenção da massagem terapêutica na saúde mental das pessoas com patologia oncológica. METODOLOGIA: Revisão sistemática da literatura, através dos descritores “pacientes”, “oncologia” e “massagem”, estudos de 2000 a 2012, em bases de dados e motores de busca online. RESULTADOS: O corpus do estudo foi composto por 15 artigos e demonstra que a massagem terapêutica reduz, quer de imediato, quer a longo prazo, a ansiedade e a depressão. Contudo, há estudos em que não existiram diferenças nestas variáveis. Esta intervenção melhora, de imediato, o relaxamento, o bem-estar emocional e o padrão de sono, a dor, o desconforto físico-emocional e a fadiga. Não houveram diferenças estatísticas significativas que corroborassem a melhoria da qualidade de vida, stress e sofrimento. CONCLUSÕES: A massagem terapêutica tem efeitos benéficos a curto prazo na saúde mental das pessoas com patologia oncológica. No entanto, relativamente à ansiedade e depressão os resultados analisados são contraditórios, reportando-se para investigações futuras. Sugerimos novas pesquisas para maior consistência empírica sobre os efeitos da intervenção da massagem terapêutica na saúde mental das pessoas com patologia oncológica e assim contribuir para a prática de uma enfermagem de excelência baseada na evidência.

Supply chain management systems benefits : the expectation-confirmation theory perspective

Organizations adopt a Supply Chain Management System (SCMS) expecting benefits to the organization and its functions. However, organizations are facing mounting challenges to realizing benefits through SCMS. Studies suggest a growing dissatisfaction among client organizations due to an increasing gap between expectations and realization of SCMS benefits. Further, reflecting the Enterprise System studies such as Seddon et al. (2010), SCMS benefits are also expected to flow to the organization throughout its lifecycle rather than being realized all at once. This research therefore proposes to derive a lifecycle-wide understanding of SCMS benefits and realization to derive a benefit expectation management framework to attain the full potential of an SCMS. The primary research question of this study is: How can client organizations better manage their benefit expectations of SCM systems? The specific research goals of the current study include: (1) to better understand the misalignment of received and expected benefits of SCM systems; (2) to identify the key factors influencing SCM system expectations and to develop a framework to manage SCMS benefits; (3) to explore how organizational satisfaction is influenced by the lack of SCMS benefit confirmation; and (4) to explore how to improve the realization of SCM system benefits. Expectation-Confirmation Theory (ECT) provides the theoretical underpinning for this study. ECT has been widely used in the consumer behavior literature to study customer satisfaction, post-purchase behavior and service marketing in general. Recently, ECT has been extended into Information Systems (IS) research focusing on individual user satisfaction and IS continuance. However, only a handful of studies have employed ECT to study organizational satisfaction on large-scale IS. The current study will enrich the research stream by extending ECT into organizational-level analysis and verifying the preliminary findings of relevant works by Staples et al. (2002), Nevo and Chan (2007) and Nevo and Wade (2007). Moreover, this study will go further trying to operationalize the constructs of ECT into the context of SCMS. The empirical findings of the study commence with a content analysis, through which 41 vendor reports and academic reports are analyzed yielding sixty expected benefits of SCMS. Then, the expected benefits are compared with the benefits realized at a case organization in the Fast Moving Consumer Goods industry sector that had implemented a SAP Supply Chain Management System seven years earlier. The study develops an SCMS Benefit Expectation Management (SCMS-BEM) Framework. The comparison of benefit expectations and confirmations highlights that, while certain benefits are realized earlier in the lifecycle, other benefits could take almost a decade to realize. Further analysis and discussion on how the developed SCMS-BEM Framework influences ECT when applied in SCMS was also conducted. It is recommended that when establishing their expectations of the SCMS, clients should remember that confirmation of these expectations will have a long lifecycle, as shown in the different time periods in the SCMS-BEM Framework. Moreover, the SCMS-BEM Framework will allow organizations to maintain high levels of satisfaction through careful mitigation and confirming expectations based on the lifecycle phase. In addition, the study reveals that different stakeholder groups have different expectations of the same SCMS. The perspective of multiple stakeholders has significant implications for the application of ECT in the SCMS context. When forming expectations of the SCMS, the collection of organizational benefits of SCMS should represent the perceptions of all stakeholder groups. The same mechanism should be employed in the measurements of received SCMS benefits. Moreover, for SCMS, there exists interdependence of the satisfaction among the various stakeholders. The satisfaction of decision-makers or the authorized staff is not only driven by their own expectation confirmation level, it is also influenced by the confirmation level of other stakeholders‘ expectations in the organization. Satisfaction from any one particular stakeholder group can not reflect the true satisfaction of the client organization. Furthermore, it is inferred from the SCMS-BEM Framework that organizations should place emphasis on the viewpoints of the operational and management staff when evaluating the benefits of SCMS in the short and middle term. At the same time, organizations should be placing more attention on the perspectives of strategic staff when evaluating the performance of the SCMS in the long term.

α-Synuclein pathology in very elderly Finns : A population-based clinico-neuropathologic and molecular genetic study of Dementia with Lewy bodies

Populations in developed countries are ageing fast. The elderly have the greatest incidence of de-mentia, and thus the increase in the number of demented individuals, increases the immediate costs for the governments concerning healthcare and hospital treatment. Attention is being paid to disorders behind cognitive impairment with behavioural and psychological symptoms, which are enormous contributors to the hospital care required for the elderly. The highest dreams are in prevention; however, before discovering the tools for preventing dementia, the pathogenesis behind dementia disorders needs to be understood. Dementia with Lewy bodies (DLB), a relatively recently discovered dementia disorder compared to Alzheimer’s disease (AD), is estimated to account for up to one third of primary degenerative dementia, thus being the second most common cause of dementia in the elderly. Nevertheless, the impact of neuropathological and genetic findings on the clinical syndrome of DLB is not fully established. In this present series of studies, the frequency of neuropathological findings of DLB and its relation to the clinical findings was evaluated in a cohort of subjects with primary degenerative dementia and in a population-based prospective cohort study of individuals aged 85 years or older. α-synuclein (αS) immunoreactive pathology classifiable according to the DLB consensus criteria was found in one fourth of the primary degenerative dementia subjects. In the population-based study, the corresponding figure was one third of the population, 38% of the demented and one fifth of the non-demented very elderly Finns. However, in spite of the frequent discovery of αS pathology, its association with the clinical symptoms was quite poor. Indeed, the common clinical features of DLB, hypokinesia and visual hallucinations, associated better with the severe neurofibrillary AD-type pathology than with the extensive (diffuse neocortical) αS pathology when both types of pathology were taken into account. The severity of the neurofibrillary AD-type pathology (Braak stage) associated with the extent of αS pathology in the brain. In addition, the genetic study showed an interaction between tau and αS; common variation in the αS gene (SNCA) associated significantly with the severity of the neurofibrillary AD-type pathology and nominally significantly with the extensive αS pathology. Further, the relevance and temporal course of the substantia nigra (SN) degeneration and of the spinal cord αS pathology were studied in relation to αS pathology in the brain. The linear association between the extent of αS pathology in the brain and the neuron loss in SN suggests that in DLB the degeneration of SN proceeds as the αS pathology extends from SN to the neocortex instead of early destruction of SN seen in Parkinson’s disease (PD). Furthermore, the extent of αS pathology in the brain associated with the severity of αS pathology in the thoracic and sacral autonomic nuclei of the spinal cord. The thoracic αS pathology was more common and more severe compared to sacral cord, suggesting that the progress of αS pathology proceeds downwards from the brainstem towards the sacral spinal cord.

Target Cell Topography and Cytoskeletal Reorganization in Natural Killer Cell Activity

The immune system has to recognize and destroy abnormal or infected cells to maintain homeostasis. Natural killer (NK) cells directly recognize and kill transformed or virus-infected cells without prior sensitization. We have studied both virus-infected and tumor cells in order to identify the target structures involved in triggering NK activity. Mouse/human cell hybrids containing various human chromosomes were used as targets. The human chromosome responsible for activating NK cell killing was identified to chromosome number 6. The results suggest that activated NK cells recognize ligands that are encoded on human chromosome 6. We showed that the ligand on the target cell side was intercellular adhesion molecule 2 (ICAM-2). There was no difference in the level of expression of ICAM-2, however, but a drastic difference was seen in the distribution of the molecule: ICAM-2 was evenly distributed on the surface of the NK-resistant cells, but almost totally redistributed to the tip of uropods, bud-like extensions, which were absent from the parental cells. Interestingly, the gene coding for cytoskeletal linker protein ezrin has been localized to human chromosome 6, and there was a colocalization of ezrin and ICAM-2 in the uropods. Furthermore, the transfected human ezrin into NK cell-resistant cells induced uropod formation, ICAM-2 and ezrin redistribution to newly formed uropods, and sensitized target cells to NK cell killing. These data reveal a novel form of NK cell recognition: target structures are already present on normal cells; they become detectable only after abnormal redistribution into hot spots on the target cell membrane. NK cells are central players in the defence against virus infections. They inhibit the spread of infection, allowing time for specific immune responses to develop. The virus-proteins that directly activate human NK cell killing are largely unknown. We studied the sensitivity of virus-specific early proteins of Semliki Forest virus (SFV) to NK killing. The viral non-structural proteins (nsP1-4) translated early in the virus cycle were transfected in NK-resistant cells. Viral early gene nsP1 alone efficiently sensitized target cells to NK activity, and the tight membrane association of nsP1 seems to be critical in the triggering of NK killing. NsP1 protein colocalized with (redistributed) ezrin in filopodia-like structures to which the NK cells were bound. The results suggest that also in viral infections NK cells react to rapid changes in membrane topography. Based on the results of this thesis, a new model of target cell recognition of NK cells can be suggested: reorganization of the cytoskeleton induces alterations in cell surface topography, and this new pattern of surface molecules is recognized as "altered-self".

Transposable elements in a marginal plant population

Background
How new forms arise in nature has engaged evolutionary biologists since Darwin's seminal treatise on the origin of species. Transposable elements (TEs) may be among the most important internal sources for intraspecific variability. Thus, we aimed to explore the temporal dynamics of several TEs in individual genotypes from a small, marginal population of Aegilops speltoides. A diploid cross-pollinated grass species, it is a wild relative of the various wheat species known for their large genome sizes contributed by an extraordinary number of TEs, particularly long terminal repeat (LTR) retrotransposons. The population is characterized by high heteromorphy and possesses a wide spectrum of chromosomal abnormalities including supernumerary chromosomes, heterozygosity for translocations, and variability in the chromosomal position or number of 45S and 5S ribosomal DNA (rDNA) sites. We propose that variability on the morphological and chromosomal levels may be linked to variability at the molecular level and particularly in TE proliferation.

Results
Significant temporal fluctuation in the copy number of TEs was detected when processes that take place in small, marginal populations were simulated. It is known that under critical external conditions, outcrossing plants very often transit to self-pollination. Thus, three morphologically different genotypes with chromosomal aberrations were taken from a wild population of Ae. speltoides, and the dynamics of the TE complex traced through three rounds of selfing. It was discovered that: (i) various families of TEs vary tremendously in copy number between individuals from the same population and the selfed progenies; (ii) the fluctuations in copy number are TE-family specific; (iii) there is a great difference in TE copy number expansion or contraction between gametophytes and sporophytes; and (iv) a small percentage of TEs that increase in copy number can actually insert at novel locations and could serve as a bona fide mutagen.

Conclusions
We hypothesize that TE dynamics could promote or intensify morphological and karyotypical changes, some of which may be potentially important for the process of microevolution, and allow species with plastic genomes to survive as new forms or even species in times of rapid climatic change.

Prognostic significance of cyclooxygenase-2 and associated molecules in gastric cancer

Background and aims: Low stage and curative surgery are established factors for improved survival in gastric cancer. However, not all low-stage patients have a good prognosis. Cyclooxygenase-2 (COX-2) is known to associate with reduced survival in several cancers, and has been shown to play an important role in gastric carcinogenesis. Since new and better prognostic markers are needed for gastric cancer, we studied the prognostic significance of COX-2 and of markers that associate with COX-2 expression. We also studied markers reflecting proliferation and apoptosis, and evaluated their association with COX-2. Our purpose was to construct an accurate prognostic model by combining tissue markers and clinicopathogical factors. Materials and methods: Of 342 consecutive patients who underwent surgery for gastric cancer at Meilahti Hospital, Helsinki University Central Hospital, 337 were included in this study. Low stages I to II were represented by 141 (42%) patients, and high stages III to IV by 196 (58%). Curative surgery was performed on 176 (52%) patients. Survival data were obtained from the national registers. Slides from archive tissue blocks were prepared for immunohistochemistry by use of COX-2, human antigen R (HuR), cyclin A, matrix metalloproteinases 2 and 9 (MMP-2, MMP-9), and Ki-67 antibodies. Immunostainings were scored by microscopy, and scores were entered into a database. Associations of tumor markers with clinicopathological factors were calculated, as well as associations with p53, p21, and results of flow cytometry from earlier studies. Survival analysis was performed by the Kaplan-Meier method, and Cox multivariate models were reconstructed. Cell culture experiments were performed to explore the effect of small interfering (si)RNA of HuR on COX-2 expression in a TMK-1 gastric cancer cell line. Results: Overall 5-year survival was 35.1%. Study I showed that COX-2 was an independent prognostic factor, and that the prognostic impact of COX-2 was more pronounced in low-stage patients. Cytoplasmic HuR expression also associated with reduced survival in gastric cancer patients in a non-independent manner. Cell culture experiments showed that HuR can regulate COX-2 expression in TMK-1 cells in vitro, with an association also between COX-2 and HuR tissue expression in a clinical material. In Study II, cyclin A was an independent prognostic factor and was associated with HuR expression in the gastric cancer material. The results of Study III showed that epithelial MMP-2 associated with survival in univariate, but not in multivariate analysis. However, MMP-9 showed no prognostic value. MMP-2 expression was associated with COX-2 expression. In Study IV, the prognostic power of COX-2 was compared with that of all tested markers associated with survival in Studies I to III, as well as with p21, p53, and flow cytometry results. COX-2 and p53 were independent prognostic factors, and COX-2 expression was associated with that of p53 and Ki-67 and also with aneuploidy. Conclusions: COX-2 is an independent prognostic factor in gastric cancer, and its prognostic power emerges especially in low stage cancer. COX-2 is regulated by HuR, and is associated with factors reflecting invasion, proliferation, and apoptosis. In an extended multivariate model, COX-2 retained its position as an independent prognosticator. COX-2 can be considered a promising new prognostic marker in gastric cancer.