Validation of the pre-treatment neutrophil-lymphocyte ratio as a prognostic factor in a large European cohort of renal cell carcinoma patients.

BACKGROUND: The neutrophil-lymphocyte ratio (NLR) has been proposed as an indicator of systemic inflammatory response. Several studies suggest a negative impact of increased NLR for patient's survival in different types of cancer. However, previous findings from small-scale studies revealed conflicting results about its prognostic significance with regard to different clinical end points in non-metastatic renal cell carcinoma (RCC) patients. Therefore, the aim of our study was the validation of the prognostic significance of NLR in a large cohort of RCC patients. METHODS: Data from 678 consecutive non-metastatic clear cell RCC patients, operated between 2000 and 2010 at a single centre, were evaluated retrospectively. Cancer-specific, metastasis-free, as well as overall survival (OS) were assessed using the Kaplan-Meier method. To evaluate the independent prognostic significance of NLR, multivariate Cox regression models were applied for all three different end points. Influence of the NLR on the predictive accuracy of the Leibovich prognosis score was determined by Harrell's concordance index. RESULTS: Multivariate analysis identified increased NLR as an independent prognostic factor for overall (hazard ratio (HR)=1.59, 95% confidence interval (CI)=1.10-2.31, P=0.014), but not for cancer-specific (HR=1.59, 95% CI=0.84-2.99, P=0.148), nor for metastasis-free survival (HR=1.39, 95% CI=0.85-2.28, P=0.184). The estimated concordance index was 0.79 using the Leibovich risk score and 0.81 when NLR was added. CONCLUSION: Regarding patients' OS, an increased NLR represented an independent risk factor, which might reflect a higher risk for severe cardiovascular and other comorbidities. Adding the NLR to well-established prognostic models such as the Leibovich prognosis score might improve their predictive ability.

Preschoolers' knowledge of their classroom environment: evidence from small-scale and life-size spatial tasks.

Preschoolers (N = 20) and student teachers (N = 10) were asked to reconstruct the complete layout of their familiar classroom using a small-scale model as well as using life-size furniture in their actual classroom. Children were given the model task once within a testing room (standard model) and once within their normally arranged classroom (cued model). Subjects were also given an isolated-location task in which they were asked to show the location of individual pieces of furniture, 1 at a time. Adults performed virtually perfectly on all tasks. Children demonstrated more knowledge about their classroom when no scale reduction was necessary (i.e., performance was significantly better in the classroom than on the model) and when information about spatial arrangement was available (i.e., performance on the cued model surpassed performance on the standard model). Nevertheless, some children still performed inaccurately, even with these additional aids. Results from the isolated-location task demonstrated that, when possible children rely on relational information in determining locations. Implications for conclusions about children's spatial competence are discussed.

Effects of exposure duration on part-whole perception in children.

Drawings of familiar objects arranged to suggest more general wholes (e.g., a beast made of pieces of fruit) were presented to 128 children aged 3-12 years, using 4 exposure durations. The ability to see both parts and wholes together improved with age, confirming earlier studies. In addition, the results suggest that limiting viewing time affects the ability to see both parts and wholes together (in a sequential, nonintegrated fashion) more in young children than in older children. The results further suggest that for younger children duration does not affect the ability to see parts and wholes in a hierarchical relationship. These results are interpreted as suggesting that at least 2 different processes mediate part-whole perception in children.