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PubMed2006

MPID-T: database for sequence-structure-function information on T-cell receptor/peptide/MHC interactions.

UNLABELLED: Normal adaptive immune responses operate under major histocompatibility complex (MHC) restriction by binding to specific, short antigenic peptides and presenting them to appropriate T-cell receptors (TcRs). Sequence-structure-function information is critical in understanding the principles governing peptide/MHC (pMHC) and TcR/pMHC recognition and binding. A new database for sequence-structure-function information on TcR/pMHC interactions, MHC-Peptide Interaction Database version T (MPID-T), is now available with the latest available Protein Data Bank (PDB) data and interaction parameters on TcR/pMHC complexes. MPID-T is a manually curated MySQL database containing experimentally determined structures of 187 pMHC complexes and 16 TcR/pMHC complexes available in the PDB. Each structure is manually verified, classified, and analysed for intermolecular interactions (i) between the MHC and its corresponding bound peptide and (ii) between TcR and its bound pMHC complex where TcR structural information is available. The MPID-T database retrieval system has precomputed interaction parameters that include solvent accessibility, hydrogen bonds, gap volume and gap index. Structural visualisation of the TcR/pMHC complex, pMHC complex, MHC or the bound peptide can be performed using freely available graphics applications such as MDL Chime or RasMol, while structural alignment (based on MHC class and peptide length) can be viewed using the Jmol molecular viewer or an MDL Chime-compatible web browser client. MPID-T contains structural descriptors for in-depth characterisation of TcR/pMHC and pMHC interactions. The ultimate purpose of MPID-T is to enhance the understanding of the binding mechanism underlying TcR/pMHC and pMHC interactions by mapping the TcR footprint on the MHC and its bound peptide, as this eventually determines T-cell recognition and binding. AVAILABILITY: The MPID-T database retrieval system is available at http://surya.bic.nus.edu.sg/mpidt CONTACT: Joo Chuan Tong (jctong@i2r.a-star.edu.sg).

Animals↗
PubMedDate not supplied

Use of the preoperative levels of CEA in patients with colorectal cancer.

BACKGROUND/AIMS: Preoperative carcinoembryonic antigen has been considered useful as a prognostic factor and recurrence indicator of colorectal neoplasms. However, its diagnostic ability related to some parameters such as resectability or tumor staging has been less studied. The aim of this study was to evaluate the use of this marker as a diagnostic test for these parameters of colorectal cancer. METHODOLOGY: In a sample of 283 patients operated on for colorectal carcinoma data were retrospectively recorded corresponding to preoperative carcinoembryonic antigen, type of surgery performed (curative vs. non-curative), tumor intramural spread, lymph node involvement, distant metastasis, TNM stage, tumoral differentiation, survival time and survival time free of disease. Bivariate analysis between carcinoembryonic antigen and the rest of the parameters was performed. Also, the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy (efficiency) of the marker considered as a diagnostic test, were analyzed in relation to the tumoral resectability and tumoral spread. RESULTS: Preoperative level of serum carcinoembryonic antigen was statistically significantly associated with type of surgery performed (p < 0.001); tumoral intramural spread (p = 0.001); lymph node involvement (p < 0.001); presence of distant metastasis (p < 0.001); TNM staging (p < 0.001); overall survival period (p < 0.001) and disease-free survival time (p = 0.04). There was no relation between carcinoembryonic antigen and the degree of tumoral differentiation. The carcinoembryonic antigen's greatest sensitivity corresponded with the prediction for the type of the surgery performed and with the existence of distant metastasis, 80% and 70.9%, respectively. The negative predictive value was also high (> 90% in both cases). When considering the intramural spread, the specificity was 82% and its positive predictive value 93.1%. CONCLUSIONS: Preoperative levels of serum carcinoembryonic antigen, considered as a diagnostic test, are useful as predictors of resectability and tumor spread in colorectal carcinoma.

Adult↗
PubMed2004

[Multivariate regression analysis of recurrence following curative surgery for colorectal cancer].

BACKGROUND & OBJECTIVE: Recurrence is a very important prognostic factor for colorectal cancer patients after operation. The selection of patients for individualized follow-up and adjuvant therapy after curative resection of colorectal carcinoma depends on prognostic factors for recurrence. The objective of this study was to investigate the clinicopathologic factors related to recurrence following curative surgery for colorectal cancer. METHODS: The clinicopathologic factors and follow-up data of 692 cases of colorectal cancers after surgical treatment from 1991 to 1999 were retrospectively analyzed by univariate and multivariate methods. RESULTS: The overall 3-year and 5-year survival rates were 33.1% and 19.7% in recurrent group, and 92.8% and 86.1% in nonrecurrent group, respectively. Univariate analysis showed that Dukes' stage, lymph node metastasis, tumor location, histological differentiation, gross findings and depth of bowel wall invasion were significantly associated with recurrence after operation. Multivariate analysis showed that lymph node metastasis and tumor location were prognostic factors for recurrence after operation. In separate analysis of distant metastasis and local recurrence with multivariate method, lymph node metastasis was an prognostic variable for both distant metastasis and local recurrence. Depth of bowel wall invasion was associated with distant metastasis, and tumor location was associated with local recurrence. CONCLUSION: Lymph node metastasis is the most important prognostic factor for recurrence or distant metastasis and local recurrence after operation for the patients with colorectal carcinoma. Depth of bowel wall invasion is an important prognostic factor for distant metastasis. Rectal cancer patients should be considered to have additional risks for local recurrence.

Adenocarcinoma↗
PubMed1990

[Gastric cancer in the province of Valdivia (Chile) 1977-1987].

The pathologic records of Hospital Kennedy in Valdivia include 391 cases of gastric cancer between 1977 and 1987, with a yearly incidence of 35 cases. Mean age was 58 years; 97% of males and 93% of females were 40 years or older. Surgery had been undertaken in 70%, with resection performed in 63%. Advanced lesions were found in 83% of cases, with a mean size of 35 cm (vs 15 for early lesions). Complete resection of the first lymph node barrier was performed in 83% of patients, of the second in 7%; and of the third in none. Curative surgery was felt to have been performed in 37% of patients. These data suggest the need for earlier detection of gastric cancer in our population.

Adult↗
PubMed1989

[Carcinoembryonal antigen and the follow up of patients after resection of colon carcinoma with curative intent: a Markov process in decision analysis].

The follow-up of colon cancer patients by monitoring serum carcinoembryonic antigen has advantages (better survival after early detection of recurrence by CEA rise) as well as disadvantages (false-positive rise of CEA, and early detection of incurable recurrences in asymptomatic patients). The effects of CEA follow-up on quality-adjusted life expectancy (QUALE) of patients with curatively resected colon carcinoma have been simulated by a Markov analysis using literature data. The value of CEA seems insignificant and varies, depending on the literature data used, from a mean increase of QUALE by 6 days (+0.4%) to a mean decrease by 2 days (-0.07%). This value depends on patient-related variables; the negative effects of CEA especially predominate in older patients with favourable Dukes' stages of primary tumour.

Carcinoembryonic Antigen↗
PubMed1989

[Diagnosis and treatment in general practice. 4. General practitioners' knowledge of their patients].

The object of this work is to describe aspects of general practitioners' knowledge of their patients and to analyse the connection between this knowledge and certain activities involving the patients in the practice (examination in the practice, prescription of medicine, information and referral). Fifty-five practices with a clientele of 81,600 patients in the lower income group of the Danish National Health Insurance over the age of 15 years participated. A random sample of 1/30 of the insured persons were characterized by the practice prior to a period of observation of three months on the basis of the doctors' knowledge of the persons. During the period of observation, all practice-patient contacts were registered. The characteristics of the patients included: curation of attachment to the practice, degree of knowledge, previous problems etc. Contact data included information about diagnoses, symptoms, patient's wishes, prescriptions, referrals, information given and examinations in the practice. During the three months, a total of 1,974 episodes of medical care occurred. We did not find any connection between the duration of knowledge (as a measure of knowledge) and the number of abovementioned activities in the practice. This investigation, however, cannot exclude such a connection. Information is still required to illustrate the significance of the knowledge of the patients for the solution of their problems and, in particular, for the course of their health problems.

Denmark↗
PubMed1979

[Treatment of rhabdomyosarcoma in mice C3H/He by Co 60 and hyperbaric oxygen (author's transl)].

UNLABELLED: Experimental study of rhabdomyosarcoma with successive transplantation upon C3H/He mice, treated by irradiation (Co 60) and combined irradiation-hyperbaric oxygen (HBO), dating from 3, 14 and 15 days after transplantation. The data (tumor volume evolution, histological modifications, pulmonary metastases) are compared with controls. CONCLUSIONS: curative radiotherapy depends on starting treatment as soon as possible with or without HBO. After the 14th day, sensitisation to combined HBO and C60 is seen. The extension of pulmonary metastases is a function of tumor growth. Paradoxically metastases were less frequent after HBO only and more frequent after HBO-Co 60.

Animals↗
PubMed1981

The use and non-use of preventive health services in a southern African village.

This study investigates the relationship between the health beliefs of mothers in a Botswana village and their utilization of available maternal and child health resources, specifically immunizations, antenatal care, and clinic delivery. The two-pronged methodology includes (1) a household survey of 620 mothers of children under the age of five and (2) a series of intensive but informal, loosely structured interviews with 19 village women. Results show that a majority of the children had received one immunization but that few had ever had more. Most of their mothers had attended the antenatal clinic, but fewer than 30% had made use of the village maternity service in childbirth. As predictors of these kinds of preventive behaviour, mother's age, education, use of the radio, participation in voluntary women's organizations, and material consumption were, for the most part, unimpressive. On the other hand, qualitative data from the survey and intensive interviews revealed that women were confused between curative and preventive health measures. Few respondents linked immunization with prevention of specific diseases; half the women expressed concern that the immunizations were dangerous, while others indicated lack of knowledge about the desired number; still others believed that immunizations "made the children grow". As for maternity services, the majority of women who attended the antenatal clinic had actually done so for a somatic complaint. They were responding to their perception of the clinic as a place that cures, rather than prevents, illness. This was consistent with the finding that few used the clinic delivery service: most women saw no reason to seek professional help in the absence of perceived problems. The authors point out implications of this study for community-centred, in contrast to disease-centred, health education.

Attitude to Health↗
PubMed1994

Management of the incidentally detected solid renal mass.

Solid renal masses are being increasingly detected incidentally in individuals with no urologic symptoms. Contemporary imaging modalities allow the diagnosis of RCC to be established with 85% to 90% accuracy. Some solid renal masses with radiographic characteristics of RCC will ultimately prove to be a benign adenoma or oncocytoma. Recent data suggest that radical nephrectomy and nephron-sparing surgery each provide effective curative treatment for patients with a single, small, unilateral, localized RCC. The long-term renal functional advantage of nephron-sparing surgery with a normal opposite kidney remains unproven. Radical nephrectomy remains the treatment of choice for patients with larger (> 4 cm) or multiple localized renal cell carcinomas.

Carcinoma, Renal Cell↗
PubMed1997

[Reporting maternal behavior during diarrhea in Bedouin children].

Diarrhea is still a major cause of morbidity and mortality among children in developing countries. The Bedouin population of southern Israel is in transition from a nomadic to a settled life-style. We examined maternal knowledge and reported behavior when their children had diarrhea. Mothers defined diarrhea as the passing of 4-5 stools per day. The most frequent signs of the illness were an increased number of watery stools with changes in either color or form. The most frequent symptom that prompted mothers to seek medical aid was blood in the stool. All mothers reported increasing fluid intake in their children during diarrhea, and most reported giving herbal tea. About half of the women avoided milk products and used special foods for the treatment of diarrhea. A quarter of the women reported stopping or decreasing the frequency of breast feeding during diarrhea. Reported cessation of breast feeding during diarrhea was associated with changing to special foods, and failure to note the onset of diarrhea or to recognize signs of dehydration. The withdrawal of breast feeding during episodes of illness and diarrhea is related to lack of knowledge regarding diarrhea. These data indicate that even in this population, with free access to preventive and curative medical care, there should be greater efforts to educate mothers to detect diarrheal disease and to maintain breast feeding during the diarrhea.

Arabs↗
PubMedDate not supplied

Significance of tumor markers during the follow-up of women without symptoms after treatment of primary breast cancer.

In Berlin, 23-24 February, 1995, during a "consensus-meeting" several German Oncological Societies ratified their guidelines for the follow-up after primary treatment of breast cancer. In women without symptoms and with no anamnestic or clinical signs for relapse or metastases routine X-ray diagnostics (except mammography), bone scintigraphy, ultrasound and other technical imaging procedures and laboratory evaluation including tumor markers are not obligatory. The relevance of continuously rising tumor markers (e.g. CEA, CA 15-3, MCA) without tumor-related symptoms or manifestation of relapse or metastases is not yet sufficiently studied to give exact information for specific treatment selection. Before this can be done, these factors must not only be shown to be prognostic, their therapeutic relevance must be established by controlled clinical trials. Two examples of such ongoing trials are mentioned. Today's follow-up after curative treatment of local or locoregional breast cancer is symptom-orientated. More data must be accumulated eventually showing, which subgroups of patients could profit from the very early detection of a subclinical metastasizing process. So far these data are lacking, and the use of tumor markers to intensively search for very early metastases does not help the patient or the physician. It gives rise only to unanswerable questions, is costly and time consuming and therefore seems useress.

Biomarkers, Tumor↗
PubMed1998

[Therapeutic strategies for patients with tuberculosis].

OBJECTIVES: To determine the effectiveness of strategies used to promote adherence to anti-tuberculosis treatment. SEARCH STRATEGY: MEDLINE 1966-1996 (August), Cochrane Collaboration Trials Registers (October 1996), LILACS 1982-1996 (September); reference lists in articles on adherence, contact with experts in the fields of TB and adherence research. SELECTION CRITERIA: Randomised or pseudo-randomised controlled trials of interventions to promote compliance with curative or preventive chemotherapy for TB, with at least one measure of adherence. DATA COLLECTION AND ANALYSIS: Data on study methods, participants, interventions and outcomes were collected for each study and methodological quality was assessed. Estimates of effect were assessed for categorical outcomes using the Peto odds ratio, with 95% confidence intervals. MAIN RESULTS: Strategies found to be of benefit were reminder cards sent to defaulters, assistance of patients by lay health workers, monetary incentives offered to patients, and increased supervision of TB clinic staff. It is not possible to determine from current trials whether health education by itself leads to better adherence to treatment. Even though directly-observed therapy (DOT) is widely advocated as the most cost-effective means of ensuring completion of TB treatment, no completed trials could be found which confirm or refute this view. CONCLUSIONS: RCT evidence exists that certain strategies improve adherence to anti-tuberculous therapy, and these should be adopted into clinical practice depending on their appropriateness to practice circumstances. Further innovations should be tested to find solutions that will be useful in low income countries. Randomised trials evaluating the independent effects of directly-observed therapy (DOT) are awaited.

Antitubercular Agents↗
PubMed1997

A practical prognostic index for inoperable non-small-cell lung cancer.

Radical radiotherapy is widely used to treat inoperable non-small-cell lung cancer (NSCLC) although only a small number of patients benefit in the long run from this intensive treatment. There is a small proportion of long-term survivors who might derive advantage from even more aggressive radiotherapy combined with chemotherapy. In order to support optimal treatment selection we have carried out univariate and multivariate analyses of possible prognostic variables in the retrospective data of 502 NSCLC patients treated at one institute with external radiotherapy, both with curative and palliative intent. To obtain more accurate tools for a rational treatment decision, we identified, by using Cox's proportional-hazards model, the five most powerful determinants of overall survival and combined them to a prognostic index. On the basis of only the number of these risk factors (advanced stage, general or metastatic symptoms, poor performance status, anemia and tumor size of at least 7 cm), the patient falls into one of the six possible prognostic groups and these groups turned out to be identifiable as separate prognostic clusters. Thirty-one per cent of the patients have three or more risk factors and a median survival of 5-7 months compared with 18 months for patients without any non-favorable factor. Furthermore, the prognostic factors were so strong that multivariate analyses did not reveal the treatment selection to have any significant influence on survival. As each of the five variables have the advantage of being routinely available, our index is simple enough to be used in daily clinical practice. The clinical value of the prognostic index should be verified by using independent data.

Aged↗
PubMed1998

Quality of life in patients with cancer of the esophagus and gastric cardia: a case for palliative resection.

OBJECTIVE: To evaluate quality-of-life (QOL) parameters in patients undergoing esophagectomy, curative or palliative, for carcinoma. DESIGN: Nonconsecutive case series. PATIENTS: Eighty-eight patients who underwent esophagectomy for cancer (curative, n=49 [56%]; palliative, n=39 [44%]) provided QOL assessments over an 18-month period. SETTING: Procedures for referral care were performed by a single team of clinicians in a tertiary referral center. Evaluations of QOL were made by 1 independent trained investigator. OUTCOME MEASURES: Data were documented by questionnaire at interview and parameters evaluated included an esophageal module for the type and quantity of food intake, severity of related symptoms on eating, Eastern Cooperative Oncology Groups (ECOG) performance status, sleep, pain, leisure activity, working capacity, outlook on life, general well-being, and support from family and friends. A summation of selected parameters was used to calculate a total score. RESULTS: Significant improvements were recorded in both the curative and palliative groups for at least 1 year following surgery in the type (P<.03) and quantity (P<.03) of food intake and severity of diet-related symptoms (P<.02), when compared with preoperative considerations. Findings were comparable between the groups with regard to dietary intake. Pain status and total scores were worse in the palliative group at 9 months postoperatively but no significant differences between the groups were evident at any time for sleep, leisure activity, and ECOG performance status. CONCLUSIONS: To our knowledge, there are no previous data regarding a comparison of QOL considerations in patients who have undergone either potentially curative or palliative esophagectomy for malignant disease. Data analysis revealed that palliative esophagectomy provided enhanced QOL with marked symptomatic benefits and enjoyment of daily living comparable to that observed following curative resection.

Cardia↗
PubMed2004

Postoperative follow-up strategies for patients after potentially curative surgery for colorectal cancer at Christchurch Hospital.

AIM: To describe the follow-up patterns of patients with colorectal cancer (CRC) having had surgery with curative intent. METHODS: A retrospective study was undertaken of follow-up patterns in patients who had undergone 'curative' surgery for colorectal cancer at Christchurch Hospital from 1 January 1996 to 31 December 2000. Patients were identified from three sources: the General Surgical Audit Database (Otago system), the hospital clinical Casemix DRG Database, and the Oncology Service database. Patients were included only if they had surgery with curative intent, within the stated period, and had follow-up at Christchurch Hospital. Data extracted included: patient demographics, details of initial surgery, adjuvant therapies, recurrences, and details of follow-up arrangements (including investigations). RESULTS: Of 893 patients coded as having CRC, 284 patients met the inclusion criteria. Patients were excluded for the following reasons: no operation (64), operation before 1996 (18), palliative surgery (345), previous cancer (55), no cancer (32), died within 30 days of surgery (26), follow-up outside of Christchurch region (39), and notes unavailable (30). The median age was 72 (range 28.6-99.9 years). Median follow-up time was 732 days. Most patients (91%) were followed-up by their surgeon. Patients had an average of 2.6 visits to their specialist in the first year of follow-up. Unplanned clinic visits accounted for 8.3% of all clinic visits--resulting in a number of unplanned investigations. During the follow-up period, patients had 112 colonoscopies, 68 CT scans, 8 abdominal ultrasounds, and 7 barium enemas. Recurrence was detected in 58 patients (20.4%); 23 (39.7%) recurrences were detected in the first year of follow-up. Of the 279 patients who had some form of follow-up, 9 asymptomatic patients had recurrent disease (detected as a result of a planned clinic visit) and had a potentially curative procedure for recurrence. CONCLUSIONS: The number of visits per year correlated closely with the earlier findings of Connor et al,4 however the number of investigations carried out was variable and substantially less than had been reported. Follow-up visits have limited value for the detection of asymptomatic potentially curable recurrent disease.

Adult↗
PubMed1990

[Collaboration in tumor after care with the established physician].

The organization of cancer followup, the investigations and subsequent treatment are the responsibility of only those doctors directly involved. The followup work consists of three types: diagnostic after curative treatment, therapeutic with adjuvant chemotherapy and palliative. The cooperation of hospital doctors and practitioners has proved effective. The patient's data are recorded in the accompanying documentation. The follow-up system has met with high patient compliance (94%). The drop-out rate is 6%. Twenty percent of patients with colorectal cancer who underwent curative surgery had pathologic findings. One half of them could be treated therapeutically or palliatively.

Aftercare↗
PubMed2005

DynGO: a tool for visualizing and mining of Gene Ontology and its associations.

BACKGROUND: A large volume of data and information about genes and gene products has been stored in various molecular biology databases. A major challenge for knowledge discovery using these databases is to identify related genes and gene products in disparate databases. The development of Gene Ontology (GO) as a common vocabulary for annotation allows integrated queries across multiple databases and identification of semantically related genes and gene products (i.e., genes and gene products that have similar GO annotations). Meanwhile, dozens of tools have been developed for browsing, mining or editing GO terms, their hierarchical relationships, or their "associated" genes and gene products (i.e., genes and gene products annotated with GO terms). Tools that allow users to directly search and inspect relations among all GO terms and their associated genes and gene products from multiple databases are needed. RESULTS: We present a standalone package called DynGO, which provides several advanced functionalities in addition to the standard browsing capability of the official GO browsing tool (AmiGO). DynGO allows users to conduct batch retrieval of GO annotations for a list of genes and gene products, and semantic retrieval of genes and gene products sharing similar GO annotations. The result are shown in an association tree organized according to GO hierarchies and supported with many dynamic display options such as sorting tree nodes or changing orientation of the tree. For GO curators and frequent GO users, DynGO provides fast and convenient access to GO annotation data. DynGO is generally applicable to any data set where the records are annotated with GO terms, as illustrated by two examples. CONCLUSION: We have presented a standalone package DynGO that provides functionalities to search and browse GO and its association databases as well as several additional functions such as batch retrieval and semantic retrieval. The complete documentation and software are freely available for download from the website http://biocreative.ifsm.umbc.edu/dyngo.

Computer Graphics↗
PubMed2006

A prospective comparison of multidisciplinary treatment of oesophageal cancer with curative intent in a UK cancer network.

AIMS: Combined modality therapy (with chemotherapy+/-radiotherapy) has become a standard treatment for locally advanced oesophageal cancer. However, there appears to be no compelling evidence for one treatment type or combination to suit all and at this time the clinical multi-disciplinary team (MDT) forms an important role in selecting optimal therapies for the individual. This prospective comparison in one cancer network, looks at the outcomes of this decision making process. METHODS: Over a five year period 1998-2003, data were prospectively collected on all 330 consecutive patients, referred to a tertiary specialised MDT for whom curative treatment was the planned intent. Patients were managed according to an agreed local protocol and allocated to receive one of 5 treatments: surgery alone (S), pre-operative chemotherapy (C+S), pre-operative chemo-radiotherapy (CRT+S), definitive chemo-radiotherapy (CRT) and radiotherapy alone (RT). RESULTS: The 2 and 5 year survival for all patients receiving potentially curative treatment were 49% and 26% respectively. With 2 and 5 year survival for S, CRT+S, C+S, CRT and RT being 53,21; 57,40; 37,27; 50,27; 23,0 months respectively. Of the surgical therapies, mortality was highest in the CRT+S group, versus C+S and S; 12.5%, 1.6%, 4.5% respectively (p=0.025). Non-surgical based therapies had more than double the incidence of local relapses compared to surgical based therapies; however the CRT group had an overall survival comparable with S alone. The commonest sites of distant relapse were liver (56%), lung (38%), bone (32%) and non-regional lymph nodes (24%). CONCLUSION: The results suggest that in patients who are deemed unfit for surgical intervention, definitive chemoradiotherapy remains a viable alternative; they also lend further support to selected case triple modality therapy. These areas should be further examined in the context of randomised controlled phase III trials.

Aged↗