Identification of prognostic factors for survival in patients with metastatic gastric adenocarcinoma in a Mexican population.

INTRODUCTION AND AIMS: Gastric adenocarcinoma is among the high-ranking tumors, with respect to frequency and mortality, worldwide. The inflammatory process and immune system activity are associated with oncologic control. Our aim was to identify whether the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and other variables are prognostic factors for survival in patients with metastatic gastric cancer in a Mexican population. MATERIAL AND METHODS: Patients diagnosed with metastatic gastric adenocarcinoma, hospitalized within the time frame of December 2011 to 2021, were analyzed. The NLR, PLR, and albumin and hemoglobin levels obtained from blood samples were calculated. Functional status (ECOG and Karnofsky), sex, histology, and the presence of signet ring cells were also considered possible prognostic factors. Each factor's prognostic value for overall survival was determined through univariate and multivariate analyses. RESULTS: The study included 956 patients diagnosed with metastatic gastric cancer, of whom 494 (51.7%) were men and 462 (48.3%) were women. The main histologic finding was diffuse adenocarcinoma (n = 619, 64.7%), followed by intestinal adenocarcinoma (n = 293, 30.6%), and the presence of signet ring cells was found in 659 (68.9%) patients. Diagnostic laparoscopy was performed on 238 patients (24.9%) to confirm peritoneal carcinomatosis. The multivariate analysis showed that an NLR above 3.2 (HR 1.51, 95% CI 1.27-1.8; p < 0.001), albumin below 3.5 g/dl (HR 1.25, CI 1.06-1.47; p = 0.006), and an ECOG performance status of 2 or higher (HR 1.39, CI 1.10-1.76; p = 0.005) were independent factors that predicted a lower survival rate, whereas a Karnofsky score above 70% (HR 0.69, CI 0.53-0.91; p = 0.008) was associated with a better survival rate. Lastly, the PLR was not statistically significant in the multivariate analysis. CONCLUSIONS: The NLR, nutritional status assessed through albumin measurement, and functional status can act as independent prognostic survival factors in hospitalized Mexican patients diagnosed with metastatic gastric adenocarcinoma and be taken into account during therapeutic decision-making.

Global change impacts on wheat production along an environmental gradient in south Australia.

Crop production is likely to change in the future as a result of global changes in CO2 levels in the atmosphere and climate. APSIM, a cropping system model, was used to investigate the potential impact of these changes on the distribution of cropping along an environmental transect in south Australia. The effects of several global change scenarios were studied, including: (1) historical climate and CO2 levels, (2) historic climate with elevated CO2 (700 ppm), (3) warmer climate (+2.4 degrees C) +700 ppm CO2, (4) drier climate (-15% summer, -20% winter rainfall) +2.4 degrees C +700 ppm CO2, (5) wetter climate (+10% summer rainfall) +2.4 degrees C +700 ppm CO2 and (6) most likely climate changes (+1.8 degrees C, -8% annual rainfall) +700 ppm CO2. Based on an analysis of the current cropping boundary, a criterion of 1 t/ha was used to assess potential changes in the boundary under global change. Under most scenarios, the cropping boundary moved northwards with a further 240,000 ha potentially being available for cropping. The exception was the reduced rainfall scenario (4), which resulted in a small retreat of cropping from its current extent. However, the impact of this scenario may only be small (in the order of 10,000-20,000 ha reduction in cropping area). Increases in CO2 levels over the current climate record have resulted in small but significant increases in simulated yields. Model limitations are discussed.

Nickel hypersensitivity-related periodontitis.

As the cost of providing dental care escalates, there has been a substantial increase in the substitution of nonprecious alloys for gold and precious metals found in porcelain-fused-to-metal crowns. These alloys are frequently 69% to 81% nickel. Nickel hypersensitivity is quite common in the general population and periodontal responses have been associated with nickel-containing crowns in nickel-sensitive individuals. In this article, the authors report the case of a nickel-sensitive patient who demonstrated loss of alveolar bone after the placement of crowns with a high nickel content. Nonprecious alloy crowns can be well tolerated in most cases, however, a history of metal sensitivity should be evaluated.

Free gingival grafts. Current indications and techniques.

The free gingival graft is a simple, predictable technique for increasing the zone of attached gingiva. Dentists interested in performing minor surgical procedures should include the free gingival graft in their armamentarium. Indications and contraindications have been established, but the decision regarding the adequacy of the attached gingiva remains one of clinical judgment. The clinician must evaluate several variables, including the width of the attached gingiva, the patient's age, recession history, oral hygiene practices, teeth involved, and dental records. In the opinion of the authors, the free gingival graft usually should not be used in areas of inadequate attached gingiva when root coverage is indicated. Other techniques are more predictable and yield a more esthetic result.

Some test correlates of high level creativity in architects.

The Rorschachs of 40 eminent architects, intensively studied at the Institute of Personality Assessment and Research (California) in 1959, were analyzed in terms of styles of responding (cognitive-affective controls). Level of creative talent (assessed by a competent jury of peers) was not related to styles of responding but the Rorschach data give us reason to believe that subjects with high degrees of repressive control may be more limited in creative expression. Qualitative analysis of Rorschach content suggests drive level is related to creative excellence.

Medical school graduates who leave California. A study at the University of California, San Francisco.

A follow-up survey of 1,087 physicians who had graduated from the University of California, San Francisco, School of Medicine from 1951 through 1971 was completed in 1977. A total of 307 (28.2 percent) of these persons were found to have left California. Comparison of the 307 who left with the 780 who remained showed only slight and statistically insignificant differences on most variables, such as sex, academic performance in premedical and medical education, educational level and social class of parents, age at entry into medical school, ratings by admissions interviewers, choice of specialty and a wide variety of personality inventory measures. Among the variables that did differentiate were place of birth, location and prestige of premedical college, preferences for subjects in the sciences and the humanities, and the Medical College Admission Test (MCAT) scores for quantitative ability and general information. However, attempts to combine these individual differentiators into clusters or equations from which to forecast emigration from California were unsuccessful.

A comparison of medical students from medical and nonmedical families.

A total of 1,195 students from 11 classes at the University of California, San Francisco, School of Medicine was studied. Of these, 162 were from medical and 1,033 from nonmedical families. Those from medical families were insignificantly different from their classmates on premedical scholastic achievement and Medical College Admission Test scores, but they were slightly younger and attended more prestigious undergraduate colleges. Academic and clinical performance in medical school was equivalent for the two groups. However, long-range consequences in regard to choice of specialty were observable. Psysicians from medical families were more likely than their peers to be in ophthalmology and otorhinolarngoloy, dermatology, and surgery and less likely to be in psychiatry, pediatrics, and obstericsgynecology.

Number of children wanted and expected by American physicians.

Seven hundred thrity-five male and 93 female physicians indicated the number of children they would like to have; 713 and 89 indicated the number they expected to have. These questionnaire responses were related to demographic, educational, and personality test data gathered while the physicians were in medical school. The strongest predictor of both number of children wanted and expected was the size of the physician's own family of origin. Specialists in obstetrics and gynecology wanted and expected more children than those in other specialties.

An attempt to predict graduation from medical school.

Although there is less attrition from medical school now than in prior years, 500 or more students can be expected to withdraw from American medical schools during each academic year. Continuing study of the problem is, therefore, warranted. Personality inventory, cognitive, and application data, all gathered at the time of admission, were examined for 1,014 graduates and 57 dropouts; separate analyses were conducted for the 17 who departed for academic reasons and the 40 whose attrition was attributable to other causes. Correlational analyses were also conducted in which graduates, nonacademic dropouts, and academic dropouts were scaled in a 4-3-1 continuum. The best predictor of this graduation versus dropout hierarchy was given by a six-variable combination, including scores on the Quantitative ability subtest of the Medical College Admission Test and premedical grades for the last two terms, with positive weightings; personality inventory scales for status potential, socialization, and communality, also with positive weightings; and a personality scale for conformist achievement drive, weighted negatively.

Histopathologic features of the initial and early stages of experimental gingivitis in man.

The pathologic alterations occurring in the gingival tissues of humans immediately following the beginning of plaque accumulation have not heen elucidated previously. Seven males, 22--31 years of age, free of clinical manifestations of dental and periodontal disease, and exhibiting a Plaque Index score of zero for the previous 28 days served as subjects. Plaque control measures were discontinued for 8 days and biopsies were taken from the buccal marginal gingiva of the first premolars on days 0, 2, 4, and 8. Paraffin- and Epon-embedded section, treated with a variety of histochemical stains were analyzed microscopically and cell counts were done on 1-micron Epon section. At 2 and 4 days following the beginning of plaque accumulation, the vessels subjacent to the juctional epithelium exhibited vasculitis and alterations in the perivascular collagen. There was a statistically significant increase in the number of neutrophils residing in the junctional epithelium. By the end of the 8-day period, the number of small mononuclear cells, mostly lymphocytes, in the connective tissues had increased by 3-fold and the area of collagen fiber alteration by 4-fold. In addition, the number of fibroblasts per unit area of connective tissue decreased significantly. Thus, within the period of 8 days following the beginning of plaque accumulation, an early lesion exhibiting many features characteristic of delayed hypersensitivity develops.