A simplified tumor regression grade correlates with survival in locally advanced rectal carcinoma treated with neoadjuvant chemoradiotherapy.

BACKGROUND: Locally advanced rectal cancer is frequently treated with neoadjuvant chemoradiotherapy to reduce local recurrence and possibly improve survival. The tumor response to chemoradiotherapy is variable and may influence the prognosis after surgery. This study assessed tumor regression and its influence on survival in patients with rectal cancer treated with chemoradiotherapy followed by curative surgery. METHODS: One hundred twenty-six patients with locally advanced rectal cancer (T3/T4 or N1/N2) were treated with chemoradiotherapy followed by total mesorectal excision. Patients received long-course radiotherapy (50 Gy in 25 fractions) in combination with 5-flourouracil over 5 weeks. By means of a standardized approach, tumor regression was graded in the resection specimen using a 3-point system related to tumor regression grade (TRG): complete or near-complete response (TRG1), partial response (TRG2), or no response (TRG3). RESULTS: The 5-year disease-free survival was 72% (median follow-up 37 months), and 7% of patients had local recurrence. Chemoradiotherapy produced downstaging in 60% of patients; 21% of patients experienced TRG1. TRG1 correlated with a pathological T0/1 or N0 status. Five-year disease-free survival after chemoradiotherapy and surgery was significantly better in TRG1 patients (100%) compared with TRG2 (71%) and TRG3 (66%) (P = .01). CONCLUSION: Tumor regression grade measured on a 3-point system predicts outcome after chemoradiotherapy and surgery for locally advanced rectal cancer.

The mouth-body split: conceptual models of oral health and their relationship to general health among ethnic minorities in South Thames Health Region.

OBJECTIVE: To identify and describe conceptual models of oral health shared by people from different minority ethnic groups, in particular the relationship between 'oral health' and 'general health'. To identify how these conceptions vary across social factors. BASIC RESEARCH DESIGN: In-depth interviews. Analysis of the interview data to identify the conceptual models used by participants in discussing oral health and its relationship to general health. PARTICIPANTS: Ninety-five individuals from different ethnic groups. RESULTS: Two models of 'health' were identified. The first reflected a traditional model which related health to the absence of disease. The second encompassed a broad definition of health including not only physical but social and psychological well-being and the ability to carry out everyday functions. The model within which an individual operated was influenced by ethnicity and gender. Additionally, two models of the relationship between oral health and general health were identified: one in which the two concepts were seen as separate but related; the other in which oral health and general health were viewed as inseparable aspects of a single dimension. CONCLUSIONS: People from minority ethnic groups vary in their understanding of oral health and its relationship to general health. This variation can be explained in part by ethnic and cultural factors. This finding has important implications both for the design of measures which seek to assess oral health related quality of life, and for the development of health promotional materials.

Differential regulation of tumour necrosis factor receptors (TNF-R) by IL-4; upregulation of P55 and P75 TNF-R on synovial joint mononuclear cells.

Interleukin 4 (IL-4) has previously been shown to downregulate the production of proinflammatory cytokines such as TNF-alpha, and hence has been considered to be a potential anti-inflammatory agent. In this study we have investigated the effects of IL-4 on the expression of both p55 and p75 TNF receptors (TNF-R) by flow cytometry and radioligand binding analyses and demonstrate that IL-4 downregulates both p55 and p75 TNF-R on HeLa and Jijoye cell lines in a dose dependent manner. IL-4 reduced the number of p55 TNF-R on HeLa cells from 6400 (Kd 5.1 nM) to 3900 (Kd 3.7 nM), and p75 TNF-R on Jijoye cells from 4800 (Kd 1.6 nM) to 3250 (Kd 1.5 nM). However, different effects were observed on peripheral blood mononuclear cells (PBMC). IL-4 inhibited the increase in p55 and p75 TNF-R on PBMC following adherence, whereas IL-4 upregulated p75 TNF-R expressed on PHA induced T cell blasts. To assess further the possible anti-inflammatory properties of IL-4, we studied its effects on synovial joint mononuclear cell cultures from 15 patients with inflammatory synovitis. In contrast to the differential effects of IL-4 on monocytes and T cells, IL-4 upregulated both p55 (P < 0.05) and p75 TNF-R (P < 0.005) on synovial joint cells in culture. IL-4 treatment caused a small decrease in levels of bioactive TNF-alpha in RA synovial culture supernatants, together with an increase in soluble p75 TNF-R levels although differences were not significant.(ABSTRACT TRUNCATED AT 250 WORDS)

Manchineel keratoconjunctivitis.

The Manchineel tree is an evergreen widely distributed in tropical regions. The toxic nature of Manchineel has been known since the early sixteenth century. Contact with its milky sap (latex) produces bullous dermatitis and acute keratoconjunctivitis. We identified 19 patients who had ocular injuries caused by Manchineel between 1985 and 1990 and were able to review 12. All of these patients had been treated by lavage, cycloplegia, and topical antibiotics. Of 20 episodes of exposure 14 affected both eyes. The cornea was damaged in 16 episodes, the extent varying from large corneal epithelial defects to superficial punctate keratitis. The epithelial changes had resolved in a mean period of 3.75 days (range 1 to 14 days). Two episodes caused stromal infiltration to appear and in one of these a stromal opacity remained 5 years later. The final visual acuity was 6/9 or better in all eyes except in one patient who had visual impairment because of glaucoma. Our results suggest that despite the severity of the acute reaction, the long term visual prognosis is excellent in Manchineel keratoconjunctivitis. The historical and toxicological literature on Manchineel is reviewed.