The detection of serum tumor marker becomes a common method for screening tumors. However,
this method has not been widely used for routine gastric cancer screening. In this study we aimed to determine
whether the combined use of tumor markers may increase the sensitivity for the diagnosis of gastric cancer.
This study compared levels of three tumor markers (CEA, CA 19-9, and CA 72-4) in the blood of 25 colon cancer patients and 35 healthy controls. CA72-4 and CEA levels were significantly higher in patients than controls, while CA19-9 was not. Of the three markers, CA72-4 had the highest sensitivity (82.86%) and specificity (100%) for detecting colon cancer based on receiver operating characteristic analysis. The study concludes that CA72-4 shows promise as a diagnostic marker for colon cancer.
This meta-analysis examined the association between gastric atrophy and the risk of three cancer types. Eighteen studies involving histological or serum biomarker assessments of gastric atrophy were included. The results found a two- to threefold increased risk of gastric cardia adenocarcinoma and oesophageal squamous cell carcinoma in people with gastric atrophy. However, gastric atrophy may be associated with a reduced risk of oesophageal adenocarcinoma. Further research is needed to establish the association between gastric atrophy and oesophageal adenocarcinoma risk and investigate the mechanisms for the increased risk of gastric cardia adenocarcinoma.
This document discusses screening for early detection of ovarian cancer. Pelvic examinations are currently the standard screening method, but evidence shows they often find benign conditions and lead to unnecessary follow-up procedures. Blood tests measuring tumor markers and imaging tests also have limitations in screening. While earlier detection could improve outcomes, currently available screening methods are not sufficiently effective at finding early ovarian cancers. Improved screening approaches are still needed.
This document discusses screening for ovarian cancer. It notes that ovarian cancer often presents at an advanced stage and has a poor survival rate as a result. Screening aims to detect the cancer earlier when it is more treatable. However, current screening methods like pelvic exams and the tumor marker CA-125 lack sufficient accuracy. A large clinical trial found that annual screening using transvaginal ultrasound and CA-125 did not result in earlier detection or reduced mortality compared to no screening. The high rate of false positives can lead to unnecessary surgeries, which pose risks. More accurate tests are needed for population-wide ovarian cancer screening to be effective.
This study investigated long-term survival outcomes of 320 patients who underwent radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) or colorectal liver metastases (CLM) between 1999-2010. Minimum 5-year follow-up data was available for 89% of patients, with median follow-up of 115.3 months. For HCC patients, 5-year and 10-year overall survival rates were 38.5% and 23.4%. For CLM patients, 5-year and 10-year overall survival rates were 27.6% and 15%. The study concludes RFA can provide 10-year overall survival rates of over 23% for HCC and 15% for CLM
A public webinar to increase awareness on breast cancer. This presentation covers simple facts on occurrence of breast cancer, its risk factors and various symptoms besides briefly highlighting the multitude of treatment options available. Presented in simple layman terms for broad understanding.
This document summarizes a talk on follow-up approaches for colorectal cancer patients. It discusses the rationale for follow-up to increase survival and prevent new cancers. It reviews different follow-up strategies from trials, guidelines, and the CEAwatch study. While some trials found more intense follow-up can improve survival, the optimal combination and frequency of tests is still unknown.
This study compared levels of three tumor markers (CEA, CA 19-9, and CA 72-4) in the blood of 25 colon cancer patients and 35 healthy controls. CA72-4 and CEA levels were significantly higher in patients than controls, while CA19-9 was not. Of the three markers, CA72-4 had the highest sensitivity (82.86%) and specificity (100%) for detecting colon cancer based on receiver operating characteristic analysis. The study concludes that CA72-4 shows promise as a diagnostic marker for colon cancer.
This meta-analysis examined the association between gastric atrophy and the risk of three cancer types. Eighteen studies involving histological or serum biomarker assessments of gastric atrophy were included. The results found a two- to threefold increased risk of gastric cardia adenocarcinoma and oesophageal squamous cell carcinoma in people with gastric atrophy. However, gastric atrophy may be associated with a reduced risk of oesophageal adenocarcinoma. Further research is needed to establish the association between gastric atrophy and oesophageal adenocarcinoma risk and investigate the mechanisms for the increased risk of gastric cardia adenocarcinoma.
This document discusses screening for early detection of ovarian cancer. Pelvic examinations are currently the standard screening method, but evidence shows they often find benign conditions and lead to unnecessary follow-up procedures. Blood tests measuring tumor markers and imaging tests also have limitations in screening. While earlier detection could improve outcomes, currently available screening methods are not sufficiently effective at finding early ovarian cancers. Improved screening approaches are still needed.
This document discusses screening for ovarian cancer. It notes that ovarian cancer often presents at an advanced stage and has a poor survival rate as a result. Screening aims to detect the cancer earlier when it is more treatable. However, current screening methods like pelvic exams and the tumor marker CA-125 lack sufficient accuracy. A large clinical trial found that annual screening using transvaginal ultrasound and CA-125 did not result in earlier detection or reduced mortality compared to no screening. The high rate of false positives can lead to unnecessary surgeries, which pose risks. More accurate tests are needed for population-wide ovarian cancer screening to be effective.
This study investigated long-term survival outcomes of 320 patients who underwent radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) or colorectal liver metastases (CLM) between 1999-2010. Minimum 5-year follow-up data was available for 89% of patients, with median follow-up of 115.3 months. For HCC patients, 5-year and 10-year overall survival rates were 38.5% and 23.4%. For CLM patients, 5-year and 10-year overall survival rates were 27.6% and 15%. The study concludes RFA can provide 10-year overall survival rates of over 23% for HCC and 15% for CLM
A public webinar to increase awareness on breast cancer. This presentation covers simple facts on occurrence of breast cancer, its risk factors and various symptoms besides briefly highlighting the multitude of treatment options available. Presented in simple layman terms for broad understanding.
This document summarizes a talk on follow-up approaches for colorectal cancer patients. It discusses the rationale for follow-up to increase survival and prevent new cancers. It reviews different follow-up strategies from trials, guidelines, and the CEAwatch study. While some trials found more intense follow-up can improve survival, the optimal combination and frequency of tests is still unknown.
This study evaluated the epidemiology and treatment outcomes of advanced gastric cancer in Jordan. The study compared outcomes for patients treated with two chemotherapy regimens - DCF (docetaxel, cisplatin, fluorouracil) and ECF (epirubicin, cisplatin, fluorouracil). Results showed that the DCF regimen had a higher response rate and longer time to tumor progression, but similar median survival times. Characteristics of gastric cancer patients in Jordan were similar to high-risk areas, with most cases occurring in older males. This study provides useful data on gastric cancer in the Middle East.
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
The aim of this study is to evaluate the results of liver examination by ultrasound in Najran patients during the period Dec 2011- Dec 2012, specifically to discover the rate of incidence of fatty liver and its relationship to risk factors. This is a retrospective, descriptive and quantitative case series using data collected from King Khalid hospital in Najran during the period Dec 2011- Dec 2012, where 957 patients had undergone ultrasound examination for different abdominal diseases. Data of this study was collected using a check list from the PACS (picture archive and communicating system) and the results were analyzed by using SPSS computer system. Data for a total of 957 patients who had completed abdominal ultrasound were collected. 319 were found to have fatty liver as diagnosed by ultrasound. The mean age of the study group was (49.6 ± 14.1), the mean weight was (78± 6.12), and an elevated level of ALT (alanine aminotransferase ), AST (aspartate aminotransferase) was detected in 55.7 % and 43.2% respectively . A BMI (Body mass index) > 25kg/m2 was detected in 80 % of the patient. The prevalence of NAFLD (non alcoholic fatty liver disease) was 33.3 % and it was more common in females (178, 55.4%) than in males (141, 44.1%). It is highest in the age group 40-60 years old. Diabetes was present in 24.1 % (77 patients with high fasting glucose), obesity in 45.7% (147 patients). Of the all patients, high cholesterol was present in 23, 7 % of the total. The prevalence of fatty liver in Najran patients is high. It is more common in the female than male. Obesity and diabetes are the common risk factors associated with fatty liver disease.
Colorectal cancer screening and computerized tomographic colonographySpringer
This document discusses quality considerations for colorectal cancer screening programs that utilize both optical colonoscopy and CT colonography. It notes that adenoma detection rates, colonoscopy withdrawal times, and bowel preparation quality impact the effectiveness of optical colonoscopy screening. Maintaining high quality in these areas is important for any integrated CRC screening program that uses both modalities. Fatigue in endoscopists can negatively impact adenoma detection rates, so scheduling approaches need to account for this. Effective patient education on bowel preparation is also key to ensuring screening program success and adherence.
Gemcitabine and Cisplatin In Metastatic Carcinoma Gallbladder. A Single Insti...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This study analyzed medical records of 477 obese African American patients who underwent bariatric surgery between 2004-2015. 61 patients (13%) were found to have liver conditions, of which only 6 cases (1.3% of total) were diagnosed with nonalcoholic fatty liver disease (NAFLD). Those with NAFLD had high rates of obesity-related comorbidities like hypertension, diabetes, and sleep apnea. Though the patients displayed characteristics of metabolic syndrome, the prevalence of NAFLD was low compared to other populations, possibly due to genetic or other protective factors in African Americans.
This document discusses the diagnosis and management of choledocholithiasis (CBD stones). Key points include:
- CBD stones occur in 3-10% of patients undergoing cholecystectomy and may be discovered preoperatively, intraoperatively, or postoperatively.
- Preoperative evaluation involves laboratory tests, ultrasound, CT, and MRCP to detect CBD stones. Elevated liver enzymes and bilirubin or a dilated CBD on imaging increase the likelihood of stones.
- The most common intervention for CBD stones is ERCP. Other options include intraoperative exploration or percutaneous transhepatic removal of stones. The optimal timing and approach depends on the individual clinical situation.
Genetic Syndromes and Thyroid Cancer by Pamela Brock, MS, LGCOSUCCC - James
This document discusses genetic syndromes associated with non-medullary thyroid cancer. It begins by outlining the objectives of reviewing established genetic conditions, discussing new candidate genes, and exploring genetic testing options. It then provides details on several known genetic syndromes and their associated thyroid cancer risks, including Cowden syndrome, Familial adenomatous polyposis, Carney complex, and Werner syndrome. It also discusses emerging candidate genes like CHEK2, DICER1, and MUTYH and their potential links to thyroid cancer. The document concludes by noting the low yield of genetic testing in familial non-medullary thyroid cancer cases but provides strategies to identify higher risk families.
This document discusses genetics implications for survivorship programs. It highlights identifying patients who were previously missed for genetic testing and may benefit from re-testing given advances in panel testing. It also reviews managing hereditary cancer risks and addressing the psychosocial issues patients face, such as making difficult medical decisions, informing relatives, and dealing with feelings of guilt. Survivorship programs can help such patients navigate these medical and familial implications.
This study evaluated liver stiffness measurement (LSM) and aspartate transaminase to platelet ratio index (APRI) score as non-invasive means of assessing liver fibrosis in 42 Egyptian children with chronic liver diseases. LSM using transient elastography and APRI scores were calculated and compared to liver biopsy results staged using METAVIR scoring. Both LSM and APRI score showed significant positive correlations with METAVIR fibrosis stage. LSM and APRI score were also able to reasonably differentiate between no/mild fibrosis and significant fibrosis, with LSM showing higher sensitivity and specificity at a cutoff of 8.1 kPa. The study demonstrated that LSM and APRI score can serve as useful non-invasive alternatives to biopsy
Role of Diagnostic Laparoscopy in Chronic Abdominal Conditions with Uncertain...Dr. Ashvind Bawa
A Study by Department of Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab and Department of Neurosurgery, Govind Ballabh Pant Hospital, New Delhi, India
Gastrointestinal Cancer: Research & Therapy is an open access, peer reviewed, scholarly journal dedicated to publish articles covering all areas of Gastrointestinal Cancer.
The journal aims to promote research communications and provide a forum for doctors, researchers, physicians and healthcare professionals to find most recent advances in all areas of Gastrointestinal Cancer. Gastrointestinal Cancer: Research & Therapy accepts original research articles, reviews, mini reviews, case reports and rapid communication covering all aspects of Gastrointestinal Cancer.
Gastrointestinal Cancer: Research & Therapy strongly supports the scientific up gradation and fortification in related scientific research community by enhancing access to peer reviewed scientific literary works. Austin Publishing Group also brings universally peer reviewed journals under one roof thereby promoting knowledge sharing, mutual promotion of multidisciplinary science.
Colon cancer is the fourth most common cancer in the United States. It usually starts as noncancerous polyps that slowly develop into cancer over time if left untreated. Risk factors include age over 50, family history, diet high in red meat, and certain genetic conditions. Screening tests like colonoscopy can detect colon cancer early when treatment is most effective. Treatment depends on stage and may involve surgery, chemotherapy, and radiation. With early detection and treatment, colon cancer has a good prognosis of being cured.
*Based on retrospective analysis of 2018 patients from the First BEAT trial
Okines A, et al. Br J Cancer. 2009;101:1033-1038.
*Clinical practice refers to outcomes seen in a large clinical trial, not necessarily guidelines.
Treating the Patient With Newly Diagnosed Metastatic Colorectal Cancer
clinicaloptions.com/oncology
Recommended Treatment Plan
FOLFOXIRI + bevacizumab for 6 months as neoadjuvant
therapy
Re-evaluate for resection after 3 months of therapy
If resection possible after 6 months, proceed with
resection
1. Gastrointestinal tumor markers can be used for diagnosis, staging, prognosis, monitoring treatment, and detecting cancer recurrence. However, they lack specificity and sensitivity for early-stage cancers.
2. CEA is the most useful marker for colorectal cancer, correlating with disease stage and prognosis. It can detect recurrence earlier than other methods but lacks sensitivity for early-stage disease.
3. CA19-9 is the best marker for pancreatic cancer but lacks sensitivity for early tumors. It and other markers are not proven for prognosis or monitoring.
MiRNAs for the diagnostic screening of early stages of colon cancer in stool ...Mostafa Gouda
This document summarizes various methods for screening colon cancer, including both invasive and non-invasive tests. Invasive tests like colonoscopy directly examine the colon but require bowel preparation and sedation. Non-invasive tests like fecal occult blood tests (FOBT) and fecal immunochemical tests (FIT) screen for hidden blood in stool but lack sensitivity and require multiple samples. More accurate non-invasive screening is needed. Recent research has explored microRNA biomarkers extracted from stool or blood as a potential screening method, as microRNAs are stable and their expression levels could indicate early cancer. If validated, a microRNA-based screening test could enable widespread early detection of colon cancer.
1. Colon cancer is the second and third most common cancer in males and females respectively and accounts for 9% of cancer deaths.
2. Screening and lifestyle changes have led to improved outcomes, with a 55% reduction in late-stage colon cancer cases over 3 decades from screening.
3. Adjuvant chemotherapy regimens including FOLFOX, CAPOX and XELOX have improved disease-free and overall survival rates compared to 5-FU/LV alone, particularly for stage III disease.
4. Ongoing research focuses on shortening treatment duration, identifying high-risk patients who may benefit from more intensive regimens, and incorporating molecular markers to optimize adjuvant therapy
La domótica es el conjunto de tecnologías que permiten el control y automatización inteligente del hogar para proporcionar seguridad, confort y eficiencia energética. Un sistema domótico recoge información de sensores, la procesa y emite órdenes a actuadores. La domótica ha evolucionado para ofrecer más funcionalidades a menor costo y facilitar la vida en el hogar al permitir distintos usos bajo un mismo techo.
Tabla evaluaciã“n de recursos web copiagloriaivone
El documento evalúa un recurso web sobre la importancia de la videoconferencia en la educación. El recurso proporciona información sobre su autor y fuentes, y contiene información especializada y actualizada sobre el tema. El acceso al recurso no requiere software especial y está disponible de forma habitual.
This study evaluated the epidemiology and treatment outcomes of advanced gastric cancer in Jordan. The study compared outcomes for patients treated with two chemotherapy regimens - DCF (docetaxel, cisplatin, fluorouracil) and ECF (epirubicin, cisplatin, fluorouracil). Results showed that the DCF regimen had a higher response rate and longer time to tumor progression, but similar median survival times. Characteristics of gastric cancer patients in Jordan were similar to high-risk areas, with most cases occurring in older males. This study provides useful data on gastric cancer in the Middle East.
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
The aim of this study is to evaluate the results of liver examination by ultrasound in Najran patients during the period Dec 2011- Dec 2012, specifically to discover the rate of incidence of fatty liver and its relationship to risk factors. This is a retrospective, descriptive and quantitative case series using data collected from King Khalid hospital in Najran during the period Dec 2011- Dec 2012, where 957 patients had undergone ultrasound examination for different abdominal diseases. Data of this study was collected using a check list from the PACS (picture archive and communicating system) and the results were analyzed by using SPSS computer system. Data for a total of 957 patients who had completed abdominal ultrasound were collected. 319 were found to have fatty liver as diagnosed by ultrasound. The mean age of the study group was (49.6 ± 14.1), the mean weight was (78± 6.12), and an elevated level of ALT (alanine aminotransferase ), AST (aspartate aminotransferase) was detected in 55.7 % and 43.2% respectively . A BMI (Body mass index) > 25kg/m2 was detected in 80 % of the patient. The prevalence of NAFLD (non alcoholic fatty liver disease) was 33.3 % and it was more common in females (178, 55.4%) than in males (141, 44.1%). It is highest in the age group 40-60 years old. Diabetes was present in 24.1 % (77 patients with high fasting glucose), obesity in 45.7% (147 patients). Of the all patients, high cholesterol was present in 23, 7 % of the total. The prevalence of fatty liver in Najran patients is high. It is more common in the female than male. Obesity and diabetes are the common risk factors associated with fatty liver disease.
Colorectal cancer screening and computerized tomographic colonographySpringer
This document discusses quality considerations for colorectal cancer screening programs that utilize both optical colonoscopy and CT colonography. It notes that adenoma detection rates, colonoscopy withdrawal times, and bowel preparation quality impact the effectiveness of optical colonoscopy screening. Maintaining high quality in these areas is important for any integrated CRC screening program that uses both modalities. Fatigue in endoscopists can negatively impact adenoma detection rates, so scheduling approaches need to account for this. Effective patient education on bowel preparation is also key to ensuring screening program success and adherence.
Gemcitabine and Cisplatin In Metastatic Carcinoma Gallbladder. A Single Insti...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This study analyzed medical records of 477 obese African American patients who underwent bariatric surgery between 2004-2015. 61 patients (13%) were found to have liver conditions, of which only 6 cases (1.3% of total) were diagnosed with nonalcoholic fatty liver disease (NAFLD). Those with NAFLD had high rates of obesity-related comorbidities like hypertension, diabetes, and sleep apnea. Though the patients displayed characteristics of metabolic syndrome, the prevalence of NAFLD was low compared to other populations, possibly due to genetic or other protective factors in African Americans.
This document discusses the diagnosis and management of choledocholithiasis (CBD stones). Key points include:
- CBD stones occur in 3-10% of patients undergoing cholecystectomy and may be discovered preoperatively, intraoperatively, or postoperatively.
- Preoperative evaluation involves laboratory tests, ultrasound, CT, and MRCP to detect CBD stones. Elevated liver enzymes and bilirubin or a dilated CBD on imaging increase the likelihood of stones.
- The most common intervention for CBD stones is ERCP. Other options include intraoperative exploration or percutaneous transhepatic removal of stones. The optimal timing and approach depends on the individual clinical situation.
Genetic Syndromes and Thyroid Cancer by Pamela Brock, MS, LGCOSUCCC - James
This document discusses genetic syndromes associated with non-medullary thyroid cancer. It begins by outlining the objectives of reviewing established genetic conditions, discussing new candidate genes, and exploring genetic testing options. It then provides details on several known genetic syndromes and their associated thyroid cancer risks, including Cowden syndrome, Familial adenomatous polyposis, Carney complex, and Werner syndrome. It also discusses emerging candidate genes like CHEK2, DICER1, and MUTYH and their potential links to thyroid cancer. The document concludes by noting the low yield of genetic testing in familial non-medullary thyroid cancer cases but provides strategies to identify higher risk families.
This document discusses genetics implications for survivorship programs. It highlights identifying patients who were previously missed for genetic testing and may benefit from re-testing given advances in panel testing. It also reviews managing hereditary cancer risks and addressing the psychosocial issues patients face, such as making difficult medical decisions, informing relatives, and dealing with feelings of guilt. Survivorship programs can help such patients navigate these medical and familial implications.
This study evaluated liver stiffness measurement (LSM) and aspartate transaminase to platelet ratio index (APRI) score as non-invasive means of assessing liver fibrosis in 42 Egyptian children with chronic liver diseases. LSM using transient elastography and APRI scores were calculated and compared to liver biopsy results staged using METAVIR scoring. Both LSM and APRI score showed significant positive correlations with METAVIR fibrosis stage. LSM and APRI score were also able to reasonably differentiate between no/mild fibrosis and significant fibrosis, with LSM showing higher sensitivity and specificity at a cutoff of 8.1 kPa. The study demonstrated that LSM and APRI score can serve as useful non-invasive alternatives to biopsy
Role of Diagnostic Laparoscopy in Chronic Abdominal Conditions with Uncertain...Dr. Ashvind Bawa
A Study by Department of Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab and Department of Neurosurgery, Govind Ballabh Pant Hospital, New Delhi, India
Gastrointestinal Cancer: Research & Therapy is an open access, peer reviewed, scholarly journal dedicated to publish articles covering all areas of Gastrointestinal Cancer.
The journal aims to promote research communications and provide a forum for doctors, researchers, physicians and healthcare professionals to find most recent advances in all areas of Gastrointestinal Cancer. Gastrointestinal Cancer: Research & Therapy accepts original research articles, reviews, mini reviews, case reports and rapid communication covering all aspects of Gastrointestinal Cancer.
Gastrointestinal Cancer: Research & Therapy strongly supports the scientific up gradation and fortification in related scientific research community by enhancing access to peer reviewed scientific literary works. Austin Publishing Group also brings universally peer reviewed journals under one roof thereby promoting knowledge sharing, mutual promotion of multidisciplinary science.
Colon cancer is the fourth most common cancer in the United States. It usually starts as noncancerous polyps that slowly develop into cancer over time if left untreated. Risk factors include age over 50, family history, diet high in red meat, and certain genetic conditions. Screening tests like colonoscopy can detect colon cancer early when treatment is most effective. Treatment depends on stage and may involve surgery, chemotherapy, and radiation. With early detection and treatment, colon cancer has a good prognosis of being cured.
*Based on retrospective analysis of 2018 patients from the First BEAT trial
Okines A, et al. Br J Cancer. 2009;101:1033-1038.
*Clinical practice refers to outcomes seen in a large clinical trial, not necessarily guidelines.
Treating the Patient With Newly Diagnosed Metastatic Colorectal Cancer
clinicaloptions.com/oncology
Recommended Treatment Plan
FOLFOXIRI + bevacizumab for 6 months as neoadjuvant
therapy
Re-evaluate for resection after 3 months of therapy
If resection possible after 6 months, proceed with
resection
1. Gastrointestinal tumor markers can be used for diagnosis, staging, prognosis, monitoring treatment, and detecting cancer recurrence. However, they lack specificity and sensitivity for early-stage cancers.
2. CEA is the most useful marker for colorectal cancer, correlating with disease stage and prognosis. It can detect recurrence earlier than other methods but lacks sensitivity for early-stage disease.
3. CA19-9 is the best marker for pancreatic cancer but lacks sensitivity for early tumors. It and other markers are not proven for prognosis or monitoring.
MiRNAs for the diagnostic screening of early stages of colon cancer in stool ...Mostafa Gouda
This document summarizes various methods for screening colon cancer, including both invasive and non-invasive tests. Invasive tests like colonoscopy directly examine the colon but require bowel preparation and sedation. Non-invasive tests like fecal occult blood tests (FOBT) and fecal immunochemical tests (FIT) screen for hidden blood in stool but lack sensitivity and require multiple samples. More accurate non-invasive screening is needed. Recent research has explored microRNA biomarkers extracted from stool or blood as a potential screening method, as microRNAs are stable and their expression levels could indicate early cancer. If validated, a microRNA-based screening test could enable widespread early detection of colon cancer.
1. Colon cancer is the second and third most common cancer in males and females respectively and accounts for 9% of cancer deaths.
2. Screening and lifestyle changes have led to improved outcomes, with a 55% reduction in late-stage colon cancer cases over 3 decades from screening.
3. Adjuvant chemotherapy regimens including FOLFOX, CAPOX and XELOX have improved disease-free and overall survival rates compared to 5-FU/LV alone, particularly for stage III disease.
4. Ongoing research focuses on shortening treatment duration, identifying high-risk patients who may benefit from more intensive regimens, and incorporating molecular markers to optimize adjuvant therapy
La domótica es el conjunto de tecnologías que permiten el control y automatización inteligente del hogar para proporcionar seguridad, confort y eficiencia energética. Un sistema domótico recoge información de sensores, la procesa y emite órdenes a actuadores. La domótica ha evolucionado para ofrecer más funcionalidades a menor costo y facilitar la vida en el hogar al permitir distintos usos bajo un mismo techo.
Tabla evaluaciã“n de recursos web copiagloriaivone
El documento evalúa un recurso web sobre la importancia de la videoconferencia en la educación. El recurso proporciona información sobre su autor y fuentes, y contiene información especializada y actualizada sobre el tema. El acceso al recurso no requiere software especial y está disponible de forma habitual.
This very short document appears to be testing formatting and contains only a single bullet point stating "test". It does not provide enough contextual information to generate a meaningful multi-sentence summary.
Este decreto supremo aprueba el Reglamento de Seguridad y Salud Ocupacional en Minería, que consta de 396 artículos, 32 anexos y 3 guías. También establece procedimientos para verificar el origen de sustancias beneficiadas en plantas, determinar la autoridad competente cuando cambia la calificación de un titular minero, y requiere que los titulares presenten certificados anuales de inspección de depósitos de relaves y desmontes.
This document provides information about cleaning products and supplies available from a direct sales company. It includes descriptions of various microfiber cloths and mop pads for dusting and cleaning floors as well as natural cleaning and personal care products like laundry detergent, shower gel, and anti-aging skin cream. The document aims to educate new consultants about the product line and give an overview of items that can be purchased in starter kits or sold individually.
LVenture Group is a listed venture capital firm that invests in digital startups. It has a portfolio of 40 startups and creates value by transforming startups into successful companies through equity investments and an acceleration program called LUISS ENLABS. LUISS ENLABS provides startups with funding, office space, services, and access to advisors and investors to help increase their success rates. LVenture Group has competitive advantages through its integrated model that brings together venture capital investing, acceleration programs, and an ecosystem of partners.
La fluidoterapia intravenosa es una de las medidas terapéuticas más importantes en medicina de urgencias y emergencias, cuyo objetivo principal es corregir desequilibrios hidroelectrolíticos. Su uso es fundamental en cuidados críticos a pesar de requerir conocimientos sobre distribución de líquidos y desequilibrios. Existen soluciones cristaloides e isótonicas para restaurar volumen, y coloides como la albúmina para mantener la presión oncótica. Se debe monitorear signos cl
This document provides instructions and tips for roasting Green Giant Seasoned Steamers vegetables. It recommends heating the oven to 425°F, spraying or oiling a baking sheet, and roasting the frozen vegetables for 20-25 minutes or longer for potatoes. Stirring halfway through cooking and broiling for extra browning are also suggested. A variety of fresh additions like bacon, cheeses, vegetables, and herbs that can be topped on the roasted vegetables are listed.
This document provides recipes using Pillsbury products for state fair foods, including cinnamon roll waffles, ice cream sandwiches, grand cinnamon rolls, crescent corn dogs, cheese curds on a stick, and mini cinnamon roll waffles on a stick made from Pillsbury crescent dough or grand cinnamon rolls.
COUNTER TREY CONSULTING Top Of Mind Skill MarketingMike Wolinsky
This document outlines a marketing plan for an unemployed professional to find their next job. It establishes the job seeker as the CEO of their career search team. The team includes personal and professional contacts who will help uncover job opportunities. Weekly reports will be sent to the team listing interviews, potential employers to contact, and thanking those who helped. The goal is to leverage relationships to gain introductions and referrals to help open doors and find a new position.
The document outlines the services provided by the Digital Marketing Training Institute, including on-page and off-page search engine optimization, optimization of various social media platforms like Facebook and Twitter, Google AdWords advertising across different networks, and contact details for their Dadar, Andheri locations and email/website.
This study compared levels of three tumor markers (CEA, CA 19-9, and CA 72-4) in the blood of 25 colon cancer patients and 35 healthy controls. CA72-4 and CEA levels were significantly higher in colon cancer patients compared to controls, while CA19-9 levels were not significantly different. Of the three markers, CA72-4 had the highest sensitivity (82.86%) and specificity (100%) for detecting colon cancer based on receiver operating characteristic analysis. The study concludes that CA72-4 shows promise as a diagnostic marker for colon cancer screening and should be applied as a routine tumor marker test.
Colorectal cancer is the second leading cause of cancer death in western countries. Early detection through screening can prevent over 50% of deaths, but screening rates remain low. Current noninvasive screening methods like fecal occult blood tests (FOBT) have limitations in sensitivity and specificity. Blood markers like CEA, LASA, and CA19-9 are not adequate screening tools. Stool markers show more promise, like immunochemical FOBT, colonocytes, and stool DNA testing which can detect mutations. While promising, stool DNA testing needs more research on cost effectiveness and patient acceptance before being recommended for general screening. Overall, no single marker is sufficient for screening and early detection remains a challenge.
CA-125 is a protein marker that is elevated in many ovarian cancer patients. While it returns a true positive result in only 50% of stage I ovarian cancer, serial CA-125 testing over time can achieve a high specificity of 99.6%. Combining CA-125 testing with transvaginal ultrasound and examination increases accuracy for detection. HE4 is another protein marker that is elevated in epithelial ovarian cancer and not benign gynecological conditions. Using both CA-125 and HE4 tests in an algorithm called ROMA can help determine likelihood of malignancy in women with ovarian masses, outperforming CA-125 alone. ROMA and ultrasound are useful first-line tests to select high risk patients for referral and further diagn
This study evaluated the association between physicians' adenoma detection rates (the proportion of colonoscopies where an adenoma was detected) and patients' risks of subsequent colorectal cancer and death. Using data from over 300,000 colonoscopies performed by 136 gastroenterologists, the study found that higher adenoma detection rates were associated with lower risks of interval colorectal cancer (cancer diagnosed within 10 years after colonoscopy), advanced interval cancer, and death from interval cancer. Physicians with the highest detection rates had adjusted hazard ratios of 0.52 for any interval cancer, 0.43 for advanced cancer, and 0.38 for fatal interval cancer, compared to those with the lowest rates.
RESEARCH & TREATMENT NEWS: Highlights from the 2014 GI Cancer SymposiumFight Colorectal Cancer
Each January, the brightest minds in colorectal cancer research meet at the Gastrointestinal Cancer Symposium.
Fight Colorectal Cancer and The Colon Cancer Alliance are partnering to bring you the big news in colorectal cancer from the symposium. Dr. Allyson Ocean will be presenting.
Get insights about new types of treatments on the horizon, diagnostic tests available, research for upcoming drugs/biomarkers and the way colorectal cancer is treated. We’ll take a look back and a look forward. You’re not going to want to miss it.
PREDICTIVE AND DIAGNOSTIC BIOMARKERS FOR OVARIAN CANCERDr. Girija Wagh
OVARIAN CANCER HAS ELUDED SCREENING AND EARLY DETECTION . SEVERAL BIOMARKERS ARE PROPOSED AND HERE IS A AN UPDATED REVIEW OF WHAT EXISTS IN THE CURRENT CLIMATE FOR THE SAME Ovarian carcinomas relate to highest death rate in gynecologic malignancies as absence of symptoms shield the disease in the early stage. Current evidences have been devoted to discovering early effective screening mechanism prior to the onset of clinical symptoms.Serum biomarkers may aid in the diagnosis of Early ovarian cancer
Distinguish malignant from benign disease
Prevent unnecessary surgery
Improve rates of early detection. Prof Girija Wagh is the Head of the Department of OBG at Bharati University Medical College and Hospital and a well acknowledged teacher and a researcher.This overview will certainly help the learners to approach this condition with more promise
This document provides an overview of molecular diagnostic methods for liver cancer. It discusses detecting cancer-related genes, genes of related viruses like HBV and HCV, and markers of liver cancer. Common markers are alpha-fetoprotein, GGT, and CA125. Detection methods include PCR, gene chips, radioimmunoassay, ELISA, and chemiluminescent, fluorescent, and electrochemiluminescent immunoassay systems. The document concludes that combining detection of multiple markers is more effective than single markers and will improve early diagnosis as methods advance.
This document provides an overview of colorectal cancer screening. It discusses the rationale for screening, including identifying precancerous polyps and cancer at early stages to improve outcomes. Risk factors like family history and medical conditions are assessed to determine screening frequency. Guidelines recommend starting screening at age 45-50 and discontinuing it between ages 75-86 depending on risk level and life expectancy. Screening tests include stool tests done yearly and structural exams of the colon done every 5-10 years. Follow up is needed if initial screening tests abnormal results. The document highlights ensuring equitable access to screening and a need to increase screening rates in resource-limited settings.
New Predictors for Periampullary Resectabilityasclepiuspdfs
Background: Periampullary tumor involves ampullary, pancreatic, biliary and duodenal mucosa, and pancreaticoduodenectomy considered the curative option. Hence, imaging evaluation to describe the lesion is important. Furthermore, certain specific features could help in pre-operative prediction of resectability for periampullary cancers. The aim of this study is to find out any specific perioperative predictor of resectability on periampullary cancers. Patients and Methods: This is an observational cross-sectional hospital-based study done in tertiary hospital, a total of 79 patients were included in the study. Variables such as age, gender, symptoms (back pain, jaundice, etc.), investigations (bilirubin, alkaline phosphatase, etc.), and imaging (Triphasic computed tomography [CT], magnetic resonance cholangiopancreatography, endoscopic ultrasonography, etc.) were studied and the data collected and analyzed using SPSS 20. Results: Male was slightly predominant and male to female ratio was 1:0.9. The mean age was 50 years (SD ±6.54). Triphasic CT abdomen pancreatic protocol was the most effective modality of investigation. High bilirubin (>10 mg/dl) and back pain were statistically significant among patients with unresectable tumor. Conclusions: Back pain and high bilirubin could be helpful in pre-operative prediction of operability of periampullary cancers.
1) Medical oncologists may underestimate the resectability of liver metastases from colorectal cancer.
2) HIV infection does not adversely affect outcomes of liver transplantation for hepatocellular carcinoma compared to HIV-uninfected patients.
3) Early data shows promise for combining sorafenib with doxorubicin eluting bead transarterial chemoembolization for metastatic liver cancer.
Tumor markers can play roles in early detection, diagnosis, prognosis, monitoring treatment response, and detecting recurrence of certain cancers. This document discusses various tumor markers including their reference ranges, associated cancers, clinical applications, and methods of detection. Key points covered include the roles of AFP for liver cancer screening, CEA and CA19-9 for colorectal cancer monitoring, PSA for prostate cancer screening and follow up, and CA125 for ovarian cancer treatment assessment and recurrence detection. The document also provides recommendations for optimal use of tumor marker tests.
Use of MicroRNAs to Screen for Colon CancerMostafa Gouda
This document discusses using microRNAs (miRNAs) to screen for colon cancer. It notes that current screening methods like fecal occult blood tests (FOBT) and colonoscopy have limitations. FOBT lacks sensitivity and requires dietary restrictions, while colonoscopy is invasive, costly, and can lead to complications. The document proposes that a screening approach using stable miRNAs extracted from stool or blood through commercial kits could provide a more preferable noninvasive option compared to other screening methods. Such a miRNA-based test could potentially make a significant impact on preventing colon cancer if further developed and validated.
Original StudyType of Breast Cancer Diagnosis, Screening,a.docxvannagoforth
Original Study
Type of Breast Cancer Diagnosis, Screening,
and Survival
Carla Cedolini,1 Serena Bertozzi,1 Ambrogio P. Londero,2 Sergio Bernardi,3,4
Luca Seriau,1 Serena Concina,1 Federico Cattin,1 Andrea Risaliti1
Abstract
Organized, invitational breast cancer screening in our population succeeded in detecting early-stage tumors,
which have been consequently treated more frequently with breast and axillary conservative surgery, com-
plementary breast irradiation, and eventual hormonal therapy. The diagnosis of invasive cancer with screening
in our population resulted in a survival gain at 5 years from the diagnosis.
Introduction: Breast cancer screening is known to reduce mortality. In the present study, we analyzed the prevalence
of breast cancers detected through screening, before and after introduction of an organized screening, and we
evaluated the overall survival of these patients in comparison with women with an extrascreening imaging-detected
breast cancer or those with palpable breast cancers. Materials and Methods: We collected data about all women
who underwent a breast operation for cancer in our department between 2001 and 2008, focusing on type of tumor
diagnosis, tumor characteristics, therapies administered, and patient outcome in terms of overall survival, and re-
currences. Data was analyzed by R (version 2.15.2), and P < .05 was considered significant. Results: Among the 2070
cases of invasive breast cancer we considered, 157 were detected by regional mammographic screening (group A),
843 by extrascreening breast imaging (group B: 507 by mammography and 336 by ultrasound), and 1070 by extra-
screening breast objective examination (group C). The 5-year overall survival in groups A, B, and C were, respectively,
99% (95% CI, 98%-100%), 98% (95% CI, 97%-99%), and 91% (95% CI, 90%-93%), with a significant difference
between the first 2 groups and the third (P < .05) and a trend between groups A and B (P ¼ .081). Conclusion: The
diagnosis of invasive breast cancer with screening in our population resulted in a survival gain at 5 years from the
diagnosis, but a longer follow-up is necessary to confirm this data.
Clinical Breast Cancer, Vol. 14, No. 4, 235-40 ª 2014 Elsevier Inc. All rights reserved.
Keywords: Breast cancer, Breast cancer screening, Invasive breast cancer, Mammographic screening, Overall survival
Introduction
Because of the detection of early-stage tumors, breast cancer
screening reduced breast cancer mortality in Europe by 25%-31%
in patients who were invited for screening and by 38%-48% in
those who were actually screened during the last decade of the
twentieth century and the first decade of the twenty-first.1 In our
region of Italy, an organized breast cancer screening was firstly intro-
duced in 2005, but despite the high compliance of invited women
1Clinic of Surgery
2Clinic of Obstetrics and Gynecology
University of Udine, Udine, Italy
3Department of Surgery, Ospedale Civile di Latisana, Udine, Italy
4 ...
The COLONPREV trial compared fecal immunochemical testing every 2 years to a one-time colonoscopy for colorectal cancer screening in asymptomatic adults ages 50-69. An interim analysis found that FIT was non-inferior to colonoscopy for detecting colon cancer, though colonoscopy identified more adenomas. The main criticism is that the study is not yet completed, with mortality data to be collected through 2021. A limitation of FIT is that it cannot identify adenomas like colonoscopy can.
HCC Clinical update and hints from AASLD 2017 guidelines mainly about surveillance, diagnosis and treatment of Hepatocellular carcinoma in different stages.
This document describes a study that aimed to develop a blood-based long noncoding RNA (lncRNA) signature for the early detection of gastric cancer (GC). The study used a 3-phase approach involving over 2000 patients. In the discovery phase, they identified an lncRNA (GClnc1) that was upregulated in both GC tissue and circulating extracellular vesicles (EVs) and showed good diagnostic performance for early-stage GC. In validation phases using multiple cohorts, GClnc1 detected in EVs maintained high diagnostic accuracy for early-stage GC. GClnc1 levels also robustly distinguished early-stage GC from pre-cancerous lesions and GC with negative traditional biomarkers. The signature showed GC specificity
This document discusses prognostic factors in epithelial ovarian cancer. It analyzes data from 55 patients treated with primary surgery and chemotherapy between 2005-2009. The key findings are:
1. Significant prognostic factors in univariate analysis included age, histology, FIGO stage, and ascites.
2. Patients aged 70 or older and with FIGO stage IV cancer had poorer prognoses, with a 31-month survival time. Patients with endometrioid or clear cell histology had longer survival, at 51 months.
3. Subgroups like endometrioid/clear cell histology, FIGO stage II, and those with ascites were also significant prognostic factors in univariate analysis.
This document summarizes a study on prognostic factors for epithelial ovarian cancer. The study analyzed 55 patients treated with surgery and chemotherapy between 2005-2009. Key findings included:
1) Significant prognostic factors in univariate analysis were age, histology, FIGO stage, and ascites.
2) Patients aged 70 or older and with FIGO stage IV cancer had poorer prognoses, with a 31-month survival time.
3) Patients with endometrioid or clear cell histology had longer survival times at 51 months.
This document summarizes a study on prognostic factors for epithelial ovarian cancer. The study analyzed 55 patients treated with surgery and chemotherapy between 2005-2009. Key findings included:
1) Significant prognostic factors in univariate analysis were age, histology, FIGO stage, and ascites.
2) Patients aged 70 or older and with FIGO stage IV cancer had poorer prognoses, with a 31-month survival time.
3) Patients with endometrioid or clear cell histology had longer survival times at 51 months.
Similar to Combined use of AFP, CEA, CA125 and CAl9-9 improves the sensitivity for the diagnosis of gastric cancer (20)
Incidence of pneumonia and risk factors among patients with head and neck can...Enrique Moreno Gonzalez
This study investigated the incidence and patient- and treatment-related risk factors related to pneumonia acquired during radiotherapy (PNRT) in head and neck cancer (HNC) patients.
Gene expression analysis of a Helicobacter pyloriinfected and high-salt diet-...Enrique Moreno Gonzalez
Helicobacter pylori (H. pylori) infection and excessive salt intake are known as important risk factors for stomach cancer in humans. However, interactions of these two factors with gene expression profiles during gastric carcinogenesis remain unclear. In the present study, we investigated the global gene expression associated with stomach carcinogenesis and prognosis of human gastric cancer using a mouse model.
Acute myeloid leukemia (AML) is a hematopoietic malignancy with a dismal outcome in the majority of cases. A detailed understanding of the genetic alterations and gene expression changes that contribute to its pathogenesis is important to improve prognostication, disease monitoring, and therapy. In this context, leukemia-associated misexpression of microRNAs (miRNAs) has been studied, but no coherent picture has emerged yet, thus warranting further investigations.
Recently, a phase II clinical trial in hepatocellular carcinoma (HCC) has suggested that the combination of sorafenib and 5-fluorouracil (5-FU) is feasible and side effects are manageable. However, preclinical experimental data explaining the interaction mechanism(s) are lacking. Our objective is to investigate the anticancer efficacy and mechanism of combined sorafenib and 5-FU therapy in vitro in HCC cell lines MHCC97H and SMMC-7721.
Differences in microRNA expression during tumor development in the transition...Enrique Moreno Gonzalez
The prostate is divided into three glandular zones, the peripheral zone (PZ), the transition zone (TZ), and the central zone. Most prostate tumors arise in the peripheral zone (70-75%) and in the transition zone (20-25%) while only 10% arise in the central zone. The aim of this study was to investigate if differences in miRNA expression could be a possible explanation for the difference in propensity of tumors in the zones of the prostate.
Multicentric and multifocal versus unifocal breast cancer: differences in the...Enrique Moreno Gonzalez
This study compared the expression of E-cadherin, β-catenin, and MUC1 in multicentric/multifocal breast cancers versus unifocal breast cancers of identical tumor size and grade. The study found significantly downregulated expression of E-cadherin in multicentric/multifocal cancers compared to unifocal cancers. In contrast, no significant differences were seen in β-catenin expression between the two groups. Within the unifocal group, E-cadherin and β-catenin expression were positively correlated, but this was not seen in the multicentric/multifocal group. The results suggest multicentric/multifocal and unifocal breast cancers differ in E-
The life in sight application study (LISA): design of a randomized controlled...Enrique Moreno Gonzalez
It is widely recognized that spiritual care plays an important role in physical and psychosocial well-being of cancer patients, but there is little evidence based research on the effects of spiritual care. We will conduct a randomized controlled trial on spiritual care using a brief structured interview scheme supported by an e-application. The aim is to examine whether an assisted reflection on life events and ultimate life goals can improve quality of life of cancer patients.
Clinical and experimental studies regarding the expression and diagnostic val...Enrique Moreno Gonzalez
Carcinoembryonic antigen-related cell adhesion molecule 1 (CEACAM1) is a multifunctional Ig-like cell adhesion molecule that has a wide range of biological functions. According to previous reports, serum CEACAM1 is dysregulated in different malignant tumours and associated with tumour progression. However, the serum CEACAM1 expression in nonsmall-cell lung carcinomas (NSCLC) is unclear. The different expression ratio of CEACAM1-S and CEACAM1-L isoform has seldom been investigated in NSCLC. This research is intended to study the serum CEACAM1 and the ratio of CEACAM1-S/L isoforms in NSCLC.
Assessment of preoperative exercise capacity in hepatocellular carcinoma pati...Enrique Moreno Gonzalez
Cardiopulmonary exercise testing measures oxygen uptake at increasing levels of work and predicts cardiopulmonary performance under conditions of stress, such as after abdominal surgery. Dynamic assessment of preoperative exercise capacity may be a useful predictor of postoperative prognosis. This study examined the relationship between preoperative exercise capacity and event-free survival in hepatocellular carcinoma (HCC) patients with chronic liver injury who underwent hepatectomy.
Overexpression of YAP 1 contributes to progressive features and poor prognosi...Enrique Moreno Gonzalez
Yes-associated protein 1 (YAP 1), the nuclear effector of the Hippo pathway, is a key regulator of organ size and a candidate human oncogene in multiple tumors. However, the expression dynamics of YAP 1 in urothelial carcinoma of the bladder (UCB) and its clinical/prognostic significance are unclear.
CXCR7 is induced by hypoxia and mediates glioma cell migration towards SDF-1a...Enrique Moreno Gonzalez
Glioblastomas, the most common and malignant brain tumors of the central nervous system, exhibit high invasive capacity, which hinders effective therapy. Therefore, intense efforts aimed at improved therapeutics are ongoing to delineate the molecular mechanisms governing glioma cell migration and invasion.
Abnormal expression of Pygopus 2 correlates with a malignant phenotype in hum...Enrique Moreno Gonzalez
Pygopus 2 (Pygo2) is a Pygo family member and an important component of the Wnt signaling transcriptional complex. Despite this data, no clinical studies investigating Pygo2 expression in lung cancer have yet been reported.
Differentiation of irradiation and cetuximab induced skin reactions in patien...Enrique Moreno Gonzalez
In order to improve the clinical outcome of patients with locally advanced squamous cell carcinoma of the head and neck (LASCCHN) not being capable to receive platinum-based chemoradiation, radiotherapy can be intensified by addition of cetuximab, a monoclonal antibody that blocks the epidermal growth factor receptor (EGFR). The radioimmunotherapy with cetuximab is a feasible treatment option showing a favourable toxicity profile. The most frequent side effect of radiotherapy is radiation dermatitis, the most common side effect of treatment with cetuximab is acneiform rash. Incidence and severity of these frequent, often overlapping and sometimes limiting skin reactions, however, are not well explored. A clinical and molecular differentiation between radiogenic skin reactions and skin reactions caused by cetuximab which may correlate with outcome, have never been described before.
Cholestasis induces reversible accumulation of periplakin in mouse liverEnrique Moreno Gonzalez
Periplakin (PPL) is a rod-shaped cytolinker protein thought to connect cellular adhesion junctional complexes to cytoskeletal filaments. PPL serves as a structural component of the cornified envelope in the skin and interacts with various types of proteins in cultured cells; its level decreases dramatically during tumorigenic progression in human epithelial tissues. Despite these intriguing observations, the physiological roles of PPL, especially in noncutaneous tissues, are still largely unknown. Because we observed a marked fluctuation of PPL expression in mouse liver in association with the bile acid receptor farnesoid X receptor (FXR) and cholestasis, we sought to characterize the role of PPL in the liver and determine its contributions to the etiology and pathogenesis of cholestasis.
Functional p53 is required for rapid restoration of daunorubicin-induced lesi...Enrique Moreno Gonzalez
This document summarizes a research article that studied the role of p53 in daunorubicin (DNR)-induced lesions in the spleen. The key findings were:
1) DNR treatment caused more rapid cell death and weight loss in the spleens of wild type mice compared to p53-null mice.
2) While wild type mouse spleens recovered normal morphology 8 days after DNR treatment, p53-null mouse spleens still had large necrotic lesions.
3) DNR treatment increased p21 levels in wild type mice but not p53-null mice, indicating p53 is required for p21 induction.
4) The results suggest p53
Post-diagnosis hemoglobin change associates with overall survival of multiple...Enrique Moreno Gonzalez
Anemia refers to low hemoglobin (Hb) level and is a risk factor of cancer patient survival. The National Comprehensive Cancer Network recently suggested that post-diagnosis Hb change, regardless of baseline Hb level, indicates the potential presence of anemia. However, there is no epidemiological study evaluating whether Hb change has direct prognostic values for cancer patients at the population level.
Cost-effectiveness of MRI for breast cancer screening in BRCA1/2 mutation car...Enrique Moreno Gonzalez
Women with mutations in BRCA1 or BRCA2 are at high risk of developing breast cancer and, in British Columbia, Canada, are offered screening with both magnetic resonance imaging (MRI) and mammography to facilitate early detection. MRI is more sensitive than mammography but is more costly and produces more false positive results. The purpose of this study was to calculate the cost-effectiveness of MRI screening for breast cancer in BRCA1/2 mutation carriers in a Canadian setting.
Impaired mitochondrial beta-oxidation in patients with chronic hepatitis C: r...Enrique Moreno Gonzalez
Hepatic steatosis is often seen in patients with chronic hepatitis C (CH-C). It is still unclear whether these patients have an impaired mitochondrial β-oxidation. In this study we assessed mitochondrial β-oxidation in CH-C patients by investigating ketogenesis during fasting.
Intraepithelial lymphocyte distribution differs between the bulb and the seco...Enrique Moreno Gonzalez
Evaluation of intraepithelial duodenal lymphocytosis (IDL) is important in celiac disease (CD). There is no established cut-off value for increased number of IELs in the bulb. We therefore investigated the relation between IEL counts in the bulb and duodenal specimens in non-celiac subjects.
TEST BANK For Community and Public Health Nursing: Evidence for Practice, 3rd...Donc Test
TEST BANK For Community and Public Health Nursing: Evidence for Practice, 3rd Edition by DeMarco, Walsh, Verified Chapters 1 - 25, Complete Newest Version TEST BANK For Community and Public Health Nursing: Evidence for Practice, 3rd Edition by DeMarco, Walsh, Verified Chapters 1 - 25, Complete Newest Version TEST BANK For Community and Public Health Nursing: Evidence for Practice, 3rd Edition by DeMarco, Walsh, Verified Chapters 1 - 25, Complete Newest Version Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Pdf Chapters Download Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Pdf Download Stuvia Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Study Guide Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Ebook Download Stuvia Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Questions and Answers Quizlet Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Studocu Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Quizlet Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Stuvia Community and Public Health Nursing: Evidence for Practice 3rd Edition Pdf Chapters Download Community and Public Health Nursing: Evidence for Practice 3rd Edition Pdf Download Course Hero Community and Public Health Nursing: Evidence for Practice 3rd Edition Answers Quizlet Community and Public Health Nursing: Evidence for Practice 3rd Edition Ebook Download Course hero Community and Public Health Nursing: Evidence for Practice 3rd Edition Questions and Answers Community and Public Health Nursing: Evidence for Practice 3rd Edition Studocu Community and Public Health Nursing: Evidence for Practice 3rd Edition Quizlet Community and Public Health Nursing: Evidence for Practice 3rd Edition Stuvia Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Pdf Chapters Download Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Pdf Download Stuvia Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Study Guide Questions and Answers Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Ebook Download Stuvia Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Questions Quizlet Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Studocu Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Quizlet Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Stuvia
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler Community Health Nursing A Canadian Perspective, 5th Edition TEST BANK by Stamler Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Study Guide Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Studocu Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Course Hero Community Health Nursing A Canadian Perspective, 5th Edition Answers Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Course hero Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Studocu Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Study Guide Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Ebook Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Questions Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Studocu Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Stuvia
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Our backs are like superheroes, holding us up and helping us move around. But sometimes, even superheroes can get hurt. That’s where slip discs come in.
2. cancer. Our results showed that the determination of
optimal cut-off values of these markers could increase
the sensitivity for the diagnosis of gastric cancer.
Methods
Study subjects
Total 384 subjects were enrolled in this study who
visited the First Affiliated Hospital of Nanchang University
from May 2011 to May 2012, including patients with
gastric cancer and benign gastric diseases, and healthy
people who underwent physical examination. There were
149 patients in gastric cancer group (115 men, 34 women,
age range 28 to 90 years old, average 59.1 years old).
Among them, 30 patients had early gastric cancer and 119
patients had advanced gastric cancer. 71 patients had
poorly differentiated adenocarcinoma, 72 patients had
moderately differentiated adenocarcinoma, and 6 patients
had highly differentiated adenocarcinoma. 70 patients had
gastric antrum carcinoma, 61 patients had gastric body
cancer, 13 patients had gastric cardia - bottom cancer, and
5 patients had multiple site cancer (more than two sites).
There were 111 patients in benign gastric disease group
(76 men, 35 women, age range 25 to 86 years old, average
52.9 years old). Among them, 24 patients had gastric ulcer,
53 patients had duodenal ulcer, 12 patients had complex
ulcer, 17 patients had non-atrophic gastritis, and 5
patients had atrophic gastritis. 124 healthy people were
included in the control group (72 men, 52 women, age
range 37 to 83 years old, average 53.0 years old). Patients
with gastric cancer and benign gastric diseases were
diagnosed by endoscopy and confirmed by biopsy.
This study was performed in compliance with the
Helsinki Declaration and according to a protocol ap-
proved by the Medical Ethics Committee of Nanchang
University. All patients were informed about the study
and gave their consent.
Serum tumor marker detection
Serum AFP, CEA, CA125 and CA19-9 levels were
detected by using Roche electrochemiluminescence
instrument at Department of Nuclear Medicine of the
First Affiliated Hospital of Nanchang University. The
normal reference values were as follows: AFP≤7 ng/mL,
CEA≤6.5 ng/mL, CAl25≤ 35 U/mL, CAl9-9≤27 U/mL.
Statistical analysis
The data were expressed as mean ± standard deviation.
The area under curve (AUC) of receiver operating
characteristic (ROC) curve was used to evaluate the
diagnostic value of serum tumor markers. Multivariate
logistic regression analysis was used to establish the
diagnostic mathematical model. On the basis of this
model, the prediction value was calculated followed by
ROC curve analysis. The statistical analysis was
performed using SPSS17.0 statistical software (SPSS Inc.,
Chicago, IL, USA).
Results
The serum levels of CEA, CA125, CA19-9 and AFP in the
study subjects
The demographic data such as age and gender and the
test results of four serum tumor markers in gastric
cancer group, benign gastric disease group and healthy
control group were shown in Table 1. The average
serum level and the positive rate of AFP, CEA, CA125
and CA19-9 in gastric cancer group were higher than
that in the benign gastric disease group and the healthy
control group.
Positive rates of serum tumor markers in gastric cancer of
different clinicopathological features
According to the stage, location and histological differ-
entiation of gastric cancer, we subdivided gastric cancer
group and calculated positive rates of 4 serum tumor
Table 1 Serum levels of AFP CEA, CA125 and CA19-9 in the study subjects
Gastric cancer(n=149) Benign gastric disease(n=111) Healthy control(n=124) Statistic test
Age (Year) 59.1±11.5 52.9±17.4 53.0±9.6 F=10.129, P=0.000
Gender (Male/Female) 115/34 76/35 72/52 χ2
=11.460, P=0.003
AFP (ng/mL) 3.8±16.8 3.3±18.6 2.4±1.3 F=0.332, P=0.718
CEA (ng/mL) 10.5±27.8 1.9±2.8 1.4±0.9 F=11.889, P=0.000
CA125 (U/mL) 20.1±32.7 11.6±17.5 9.9±7.2 F=7.895, P=0.002
CA19-9 (U/mL) 22.8±39.1 11.4±18.7 9.5±4.7 F=10.169, P=0.000
AFP Positive cases (%) 7 (4.7) 1 (0.9) 1 (0.8) χ2
=4.838, P=0.054
CEA Positive cases (%) 26 (17.4) 2 (1.8) 0 (0.0) χ2
=38.088, P=0.000
CA125 Positive cases (%) 21(14.1) 7 (6.3) 1 (0.8) χ2
=18.934, P=0.000
CA19-9 Positive cases (%) 31(20.8) 9 (8.1) 0 (0.0) χ2
=37.840, P=0.000
Combination Positive Cases (%) 60 (40.3) 14 (12.6) 2 (1.6) χ2
=74.443, P=0.000
He et al. BMC Gastroenterology 2013, 13:87 Page 2 of 5
http://www.biomedcentral.com/1471-230X/13/87
3. markers with qualitative combined detection. The results
showed that the positive rate of serum tumor markers in
the advanced gastric cancer was higher than that in the
early gastric cancer. The positive rate of AFP, CEA and
CA19-9 with combined detection in the cardia cancer
was higher than that in the other parts. However, there
were no significant differences in the positive rate of
serum tumor markers among gastric cancer with differ-
ent differentiation (Table 2).
The association of serum tumor marker levels with the
risk of gastric cancer
To evaluate the significance of serum tumor marker
levels for the diagnosis of gastric cancer, we analyzed the
association of serum tumor marker levels with gastric
cancer in gastric cancer group. We got crude odds ratio
(OR) after logistic regression analysis (Table 3). To
exclude the possible effects of age and gender, we got
adjusted odds ratio (ORa) after the adjustment of gender
and age, and the results showed that CEA, CA125 and
CA19-9 levels were positively correlated with the risk of
gastric cancer (Table 3).
Use of normal cut-off values of serum tumor markers for
the diagnosis of gastric cancer
We took the normal value of tumor marker serum level
as cut-off value to determine the negative or positive of
gastric cancer. The results showed that the use of single
Table 2 Positive rates of 4 tumor markers with single and combined detection in gastric cancer with different stages,
location and differentiation
Cases Positive cases (%)
AFP CEA CA125 CA19-9 Qualitative combined
Stage
early stage 30 1 (3.3) 0 (0.0) 2 (6.7) 2 (6.7) 4 (13.3)
advanced stage 119 6 (5.0) 26 (21.8) 19 (16.0) 29 (24.4) 56 (47.1)
χ2
0.156 7.940 1.711 4.557 11.330
P 1.000 0.005 0.249 0.042 0.001
Location
cardia 13 2 (15.4) 5 (38.5) 1 (7.7) 6 (46.2) 9 (69.2)
gastric body 61 0 (0.0) 12 (19.7) 10 (16.4) 7 (11.5) 21 (34.4)
gastric antrum 70 5 (7.1) 9 (12.9) 10 (14.3) 18 (25.7) 30 (42.9)
multi-site 5 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0)
χ2
7.504 6.275 1.529 10.630 8.965
P 0.056 0.098 0.696 0.016 0.026
Differentiation
high 6 1 (16.7) 1 (16.7) 1 (16.7) 2 (33.3) 3 (50.0)
moderate 72 4 (5.6) 12 (16.7) 8 (11.1) 13 (18.1) 28 (38.9)
poor 71 2 (2.8) 13 (18.3) 12 (16.9) 16 (22.5) 29 (40.8)
χ2
2.599 0.070 1.024 1.031 0.303
P 0.268 0.930 0.735 0.605 0.839
Table 3 The crude odds ratio (OR) and adjusted odds ratio (ORa) between serum tumor marker levels and the risk of
gastric cancer
Indicators Crude odds ratio(OR) P Adjusted odds ratio (ORa)* P
AFP (ng/mL) 1.005 (0.991~1.019) 0.517 1.001 (0.987~1.015) 0.872
CEA (ng/mL) 1.460 (1.243~1.715) 0.000 1.389 (1.184~1.630) 0.000
CA125 (U/mL) 1.023 (1.010~1.036) 0.001 1.020 (1.006~1.034) 0.005
CA19-9 (U/mL) 1.029 (1.014~1.045) 0.000 1.026 (1.010~1.041) 0.001
combination 509.54 (90.92~2855.78) 0.000 341.87 (61.19~1910.10) 0.000
* Adjustment for age and gender.
He et al. BMC Gastroenterology 2013, 13:87 Page 3 of 5
http://www.biomedcentral.com/1471-230X/13/87
4. serum tumor marker had good specificity (96.2%-99.1%)
but poor sensitivity (4.7%-20.8%) for the diagnosis of
gastric cancer (Table 4). The sensitivity was improved
with the combined use of serum tumor markers, but
was still low (Table 4).
Use of optimum cut-off values of serum tumor markers
for the diagnosis of gastric cancer
Since the sensitivity in gastric cancer diagnosis with the
use of normal cut-off values of four serum tumor
markers was low, the potential in clinical application
would be limited. Therefore, we analyzed the serum
markers to obtain AUC of ROC curve, determined
optimum diagnostic cut-off values, and then calculated
their diagnostic values on gastric cancer. The results
showed that the use of optimum boundary values could
significantly improve the sensitivity in gastric cancer
diagnosis with CEA and combination (58.4% and 47.7%,
respectively) (Table 5).
Discussion
In this study we analyzed the diagnostic value of four
common clinical serum tumor markers AFP, CEA,
CA125 and CA19-9 for gastric cancer. We compared
the serum levels of these four markers in the gastric
cancer group, benign gastric disease group and healthy
control group, and found that the serum levels of all
four markers were higher in gastric cancer group than in
the benign gastric disease group and the healthy control
group. Especially, the serum levels of CEA, CA125 and
CA19-9 were significantly higher than in the benign
gastric disease group and the healthy control group
(P <0.005). In contrast, the serum levels of these four
markers were not significantly different between the
benign disease group and healthy control group (P =
0.581-0.844). These data suggest that these markers have
diagnostic value for gastric cancer.
When we took the normal values of four markers as
cut-off value to determine the negative or positive of
the clinical specimens, we found that the specificity of
four markers in the diagnosis of gastric cancer was
more than 95%, when used individually, but the sensi-
tivity was very low, ranging from 4.7% to 20.8%, and
AUC was no more than 0.6. Thus single marker for
clinical gastric cancer diagnosis is very limited [8].
When the four markers were combined, the sensitivity
of the diagnosis of gastric cancer reached 40.3%, but
was still not ideal.
To improve the sensitivity of gastric cancer diagnosis,
we performed logistic regression analysis and used ROC
curve to determine the optimum cut-off values. With
the use of optimum cut-off values, for CEA the
Table 4 Use of normal cut-off values of serum tumor markers for gastric cancer diagnosis
AFP CEA CA125 CA19-9 Combination
Normal boundary value ≤7 ng/mL ≤6.5 ng/mL ≤35 U/mL ≤27 U/mL -
AUC (95% CI) 0.519 0.583 0.553 0.585 0.667
(0.459~ (0.523~ (0.493~ (0.525~ (0.609~0.726)
0.579) 0.643) 0.614) 0.645)
Sensitivity (%) 4.7 17.4 14.1 20.8 40.3
Specificity (%) 99.1 99.1 96.6 96.2 93.2
Accuracy (%) 62.5 67.4 64.6 66.9 72.7
Positive/Negative predictive value (%) 77.8/62.1 92.9/65.4 72.4/63.9 77.5/65.7 78.9/71.1
Positive/negative likelihood ratio 5.52/0.96 20.5/0.83 4.14/0.89 5.43/0.82 5.91/0.64
Table 5 Use of optimal boundary values of serum tumor markers for gastric cancer diagnosis
AFP CEA CA125 CA19-9 Combination
AUC (95% CI) 0.449 0.767 0.589 0.566 0.785
(0.390~ (0.718~ (0.529~ (0.503~ (0.739~
0.509) 0.816) 0.648) 0.630) 0.832)
Positive boundary value ≥7.29 ng/mL ≥2.24 ng/mL ≥22.90 U/mL ≥19.53 U/mL ≥0.419
Sensitivity (%) 4.7 58.4 19.5 30.2 47.7
Specificity (%) 99.1 83.4 95.7 92.8 91.1
Accuracy (%) 62.5 73.7 66.1 68.5 74.2
Positive/negative predictive value (%) 77.8/62.1 69.0/76.0 74.4/65.2 72.6/67.7 77.2/73.3
Positive/Negative likelihood ratio 5.52/0.96 3.52/0.50 4.57/0.84 4.18/0.75 5.33/0.58
He et al. BMC Gastroenterology 2013, 13:87 Page 4 of 5
http://www.biomedcentral.com/1471-230X/13/87
5. sensitivity was increased from 17.4% to 58.4% (the speci-
ficity was decreased from 99.1% to 83.4%), and AUC
reached 0.767. These results are consistent with earlier
studies performed in Chinese population [5,9].
Furthermore, we investigated the relationship between
serum levels of tumor markers and clinicopathological
features of gastric cancer. We found that the positive
rates of CEA, CA19-9, and combined use of four
markers were higher in the advanced gastric cancer than
in the early gastric cancer. The positive rates of CA19-9
and combined use of four markers were higher in the
cardia cancer than in the other parts of the gastric
cancer. Our results are in agreement with previous
reports that the stage and sites of gastric cancer would
affect serum marker levels [10-12]. However, the positive
rates of markers among the gastric cancer with different
differentiation were not statistically significant, suggesting
that the differentiation has little impact on gastric
carcinoma marker level as reported previously [13].
In this study, the age and gender ratio of study sub-
jects in the three groups were statistically significant. To
avoid the possible bias caused by these factors, we
analyzed the effects of age and gender on serum levels
of the four markers in the diagnosis of gastric cancer.
We performed multivariate logistic regression analysis
and got ORa adjusted for age and gender. The results
showed that the differences in age and gender could not
change the diagnostic value of markers for gastric
cancer.
Conclusions
While the four common tumor markers when used indi-
vidually has little clinical value in the diagnosis of gastric
cancer, with the help of the ROC curve analysis and
logistic regression analysis, we could determine the
optimal cut-off values of the markers and improve the
diagnosis of gastric cancer based on these markers. These
results suggest that the optimal application of these
common tumor markers could promote the clinical
screening and diagnosis of gastric cancer.
Competing interests
The authors declared that they have no competing interest.
Authors’ contributions
KHZ, CZH and NHL designed the study; CZH, QL and XHL collected the
samples; CZH and YH detected serum marker levels; KHZ and CZH
performed statistical analysis; CZ H and KHZ drafted the manuscript. All
authors read and approved the final manuscript.
Acknowledgment
We would like to thank Dr. Yingqun Wang for his critical discussion and
editing of the manuscript.
Author details
1
Department of Gastroenterology, The First Affiliated Hospital of Nanchang
University; Jiangxi Institute of Gastroenterology & Hepatology, Nanchang,
Jiangxi 330006, China. 2
Nursing College of Nanchang University, Nanchang,
Jiangxi 330006, China.
Received: 29 December 2012 Accepted: 7 May 2013
Published: 14 May 2013
References
1. Jackson C, Cunningham D, Oliveira J, et al: Gastric cancer: ESMO clinical
recommendations for diagnosis, treatment and follow-up. Ann Oncol
2009, 20(Suppl 4):34–36.
2. Haglund C, Kuusela P, Roberts P, Jalanko H: Tumour marker CA 125 in
patients with digestive tract malignancies. Scand J Clin Lab Invest 1991,
51(3):265–270.
3. Ychou M, Duffour J, Kramar A, et al: Clinical significance and prognostic
Value of CA72-4 compared with CEA and CA19-9 in patients with gastric
cancer. Dis Markers 2000, 16(3–4):105–110.
4. Li Y, Yang Y, Lu M, et al: Predictive value of serum CEA, CA19-9 and
CA72.4 in early diagnosis of recurrence after radical resection of gastric
cancer. Hepatogastroenterology 2011, 58(112):2166–2170.
5. Bornschein J, Selgrad M, Wex T, Kuester D, Malfertheiner P:
Serological assessment of gastric mucosal atrophy in gastric cancer.
BMC Gastroenterol 2012, 12:10.
6. Zur B, Holdenrieder S, Walgenbach-Brünagel G, Albers E, Stoffel-Wagner B:
Method comparison for determination of the tumor markers AFP, CEA,
PSA and free PSA between Immulite 2000 XPI and Dimension Vista
1500. Clin Lab 2012, 58(1–2):97–105.
7. Cui W, Lu X, Zheng S, Ma Y, Liu X, Zhang W: The use of a combination of
Ki-67, Galectin-3, and PTTG can distinguish the benign and malignant
thyroid tumor. Clin Lab 2012, 58(5–6):419–426.
8. Lai IR, Lee WJ, Huang MT, et al: Comparison of serum CA72-4, CEA, TPA,
CA19-9 and CA125 levels in gastric cancer patients and correlation with
recurrence. Hepatogastroenterol 2002, 49:1157–1160.
9. Chen XZ, Zhang WK, Kun Y, et al: Correlation between serum CA724 and
gastric cancer: multiple analyses based on Chinese population. Mol Biol
Rep 2012, 39:9031–9039.
10. Duraker N, Celik AN: The prognostic significance of preoperative serum
CA 19–9 in patients with resectable gastric carcinoma: comparison with
CEA. J Surg Oncol 2001, 76(4):266–271.
11. Fan B, Xiong B: Investigation of serum tumor markers in the diagnosis of
gastric cancer. Hepatogastroenterology 2011, 58(105):239–245.
12. Mihmanli M, Dilege E, Demir U, et al: The use of tumor markers as
predictors of prognosis in gastric cancer. Hepatogastroenterology 2004,
51(59):1544–1547.
13. Wobbes T, Thomas CM, Segers MF, et al: Evaluation of seven tumor
markers (CA 50, CA 19–9, CA 19–9 TruQuant, CA 72–4, CA 195,
carcinoembryonic antigen, and tissue polypeptide antigen) in the
pretreatment sera of patients with gastric carcinoma. Cancer 1992,
69(8):2036–2041.
doi:10.1186/1471-230X-13-87
Cite this article as: He et al.: Combined use of AFP, CEA, CA125 and
CAl9-9 improves the sensitivity for the diagnosis of gastric cancer. BMC
Gastroenterology 2013 13:87.
Submit your next manuscript to BioMed Central
and take full advantage of:
• Convenient online submission
• Thorough peer review
• No space constraints or color figure charges
• Immediate publication on acceptance
• Inclusion in PubMed, CAS, Scopus and Google Scholar
• Research which is freely available for redistribution
Submit your manuscript at
www.biomedcentral.com/submit
He et al. BMC Gastroenterology 2013, 13:87 Page 5 of 5
http://www.biomedcentral.com/1471-230X/13/87