An investigation into the role of interleukin-6 in linking systemic and local inflammatory responses in patients with colorectal cancer

Colorectal cancer is the second most common cause of cancer death in the UK. It is accepted that both tumour and host factors are important determinants of disease progression and survival. While systemic and local inflammatory responses are increasingly recognized to be of particular importance the understanding of the mechanisms linking these important inflammatory processes remains unclear. This thesis examines the prognostic importance of measures of systemic and local inflammation and proposes a hypothesis for a link between tumour necrosis, systemic and local inflammatory responses in patients with colorectal cancer. Chapter 3 reports the comparison of the prognostic value of longitudinal measurements of systemic inflammation in patients undergoing curative resection of colorectal cancer. In Chapter 3 the results demonstrate that there was no significant overall change in either mGPS or NLR from pre- to post- operatively. This study highlighted the associations between pre- and post- operative mGPS and NLR and T-stage (p<0.001), TNM stage (p<0.005) and cancer-specific survival. The relationships between pre-operative measurements were examined using multivariate analysis. For pre-operative measurement both mGPS and NLR were associated with cancer-specific survival while when post-operative measures were examined only mGPS was specifically associated with cancer-specific survival (HR 4.81, CI 2.13-10.83, P<0.001). Chapter 4 examines the prognostic value of the Klintrup-Makinen scoring method and the existing limitations with regard to its clinical utility. An automated scoring method using commercially available image analysis software was developed and compared with manual scoring of tumour inflammatory infiltrates. This study demonstrated that both manual K-M scoring (p<0.001) and automated K-M scoring (p<0.05) had prognostic value in patients who had undergone potentially curative resection of colorectal cancer, and that the novel automated method may provide an objective method of assessment of tumour inflammatory infiltrates using routinely stained haematoxylin and eosin sections of tumour samples. In chapter 5 a hypothesis was proposed that Interleukin-6 may link tumour necrosis and systemic and local inflammatory responses in patients with colorectal cancer. This chapter examined the basis for this hypothesis, which is presented in figure 5.1. In addition, in chapter 5 the importance of this potential link is examined. In chapter 6, the hypothesis outlined in chapter 5 was examined in a cohort of patients who had undergone attempted curative resection of colorectal cancer. This study examined the inter-relationships between circulating mediators, in particular IL-6, tumour necrosis and systemic and local inflammatory responses. This results of this study demonstrated that IL-6 was associated with tumour necrosis (<0.001) and mGPS (<0.001) independent of T-stage. Thus adding weight to the hypothesis that elevated circulating concentrations of IL-6 may play a role in modulating both the systemic and local inflammatory responses in patients with cancer. Chapter 7 further develops the hypothesis that IL-6 signalling may be important in modulating systemic and local inflammatory responses in patients with colorectal cancer. Further, in chapter 7 the basis for the role of trans-signalling in this signaling pathway was examined. In this study, we reported that neither expression of the soluble IL-6 receptor or soluble gp130 were associated with systemic or local inflammatory responses. As a result the possible reasons for these findings were explored and future work suggested. A prospective database of patients undergoing attempted curative resection of colorectal cancer in Glasgow Royal Infirmary was used throughout this thesis. This database was created and is maintained regularly by successive research fellows at the Royal Infirmary. The work presented in this thesis highlights the importance of the host response in the form of systemic and local inflammation in patients with colorectal cancer and proposes a link between these responses and tumour necrosis. In addition, this work adds weight to the body of evidence suggesting that assessment of these host responses may improve stratification to treatment for patients with colorectal cancer. Further, this work proposes a mechanistic link, between tumour necrosis, systemic and local inflammatory responses through Interleukin-6, that merits further investigation.

Pre-colonial institutions and long-run development in Latin America

The present doctoral thesis studies the association between pre-colonial institutions and long-run development in Latin America. The thesis is organised as follows: Chapter 1 places the motivation of the thesis by underlying relevant contributions in the literature on long-run development. I then set out the main objective of the thesis, followed by a brief outline of it. In Chapter 2, I study the effects of pre-colonial institutions on present-day socioeconomic outcomes for Latin America. The main thesis of this chapter is that more advanced pre-colonial institutions relate to better socioeconomic outcomes today - principally, but not only, through their effects on the Amerindian population. I test such hypothesis with a dataset of 324 sub-national administrative units covering all mainland Latin American countries. The extensive range of controls covers factors such as climate, location, natural resources, colonial activities and pre-colonial characteristics - plus country fixed effects. Results strongly support the main thesis. In Chapter 3, I further analyse the association between pre-colonial institutions and present-day economic development in Latin America by using the historical ethnic homelands as my main unit of analysis. The main hypothesis is that ethnic homelands inhabited by more advanced ethnic groups -as measured by their levels of institutional complexity- relate to better economic development today. To track these long-run effects, I construct a new dataset by digitising historiographical maps allowing me to pinpoint the geospatial location of ethnic homelands as of the XVI century. As a result, 375 ethnic homelands are created. I then capture the levels of economic development at the ethnic homeland level by making use of alternative economic measures --satellite light density data. After controlling for country-specific characteristics and applying a large battery of geographical, locational, and historical factors, I found that the effects of pre-colonial institutions relate to a higher light density --as a proxy for economic activity- in ethnic homelands where more advanced ethnic groups lived. In Chapter 4, I explore a mechanism linking the persistence of pre-colonial institutions in Latin America over the long-run: Colonial and post-colonial strategies along with the ethnic political capacity worked in tandem allowing larger Amerindian groups to "support" the new political systems in ways that would benefit their respective ethnic groups as well as the population at large. This mechanism may have allowed the effects of pre-colonial institutions to influence socioeconomic development outcomes up to today. To shed lights on this mechanism, I combine the index of pre-colonial institutions prepared for the second chapter of the present thesis with individual-level survey data on people's attitudes. By controlling for key observable and unobservable country-specific characteristics, the main empirical results show that areas with a history of more advanced pre-colonial institutions increase the probability of individuals supporting present-day political institutions. Finally, in Chapter 5, I summarise the main findings of the thesis, and emphasise the key weaknesses of the study as well as potential avenues for future research.

The role of context in image annotation and recommendation

With the rise of smart phones, lifelogging devices (e.g. Google Glass) and popularity of image sharing websites (e.g. Flickr), users are capturing and sharing every aspect of their life online producing a wealth of visual content. Of these uploaded images, the majority are poorly annotated or exist in complete semantic isolation making the process of building retrieval systems difficult as one must firstly understand the meaning of an image in order to retrieve it. To alleviate this problem, many image sharing websites offer manual annotation tools which allow the user to “tag” their photos, however, these techniques are laborious and as a result have been poorly adopted; Sigurbjörnsson and van Zwol (2008) showed that 64% of images uploaded to Flickr are annotated with < 4 tags. Due to this, an entire body of research has focused on the automatic annotation of images (Hanbury, 2008; Smeulders et al., 2000; Zhang et al., 2012a) where one attempts to bridge the semantic gap between an image’s appearance and meaning e.g. the objects present. Despite two decades of research the semantic gap still largely exists and as a result automatic annotation models often offer unsatisfactory performance for industrial implementation. Further, these techniques can only annotate what they see, thus ignoring the “bigger picture” surrounding an image (e.g. its location, the event, the people present etc). Much work has therefore focused on building photo tag recommendation (PTR) methods which aid the user in the annotation process by suggesting tags related to those already present. These works have mainly focused on computing relationships between tags based on historical images e.g. that NY and timessquare co-exist in many images and are therefore highly correlated. However, tags are inherently noisy, sparse and ill-defined often resulting in poor PTR accuracy e.g. does NY refer to New York or New Year? This thesis proposes the exploitation of an image’s context which, unlike textual evidences, is always present, in order to alleviate this ambiguity in the tag recommendation process. Specifically we exploit the “what, who, where, when and how” of the image capture process in order to complement textual evidences in various photo tag recommendation and retrieval scenarios. In part II, we combine text, content-based (e.g. # of faces present) and contextual (e.g. day-of-the-week taken) signals for tag recommendation purposes, achieving up to a 75% improvement to precision@5 in comparison to a text-only TF-IDF baseline. We then consider external knowledge sources (i.e. Wikipedia & Twitter) as an alternative to (slower moving) Flickr in order to build recommendation models on, showing that similar accuracy could be achieved on these faster moving, yet entirely textual, datasets. In part II, we also highlight the merits of diversifying tag recommendation lists before discussing at length various problems with existing automatic image annotation and photo tag recommendation evaluation collections. In part III, we propose three new image retrieval scenarios, namely “visual event summarisation”, “image popularity prediction” and “lifelog summarisation”. In the first scenario, we attempt to produce a rank of relevant and diverse images for various news events by (i) removing irrelevant images such memes and visual duplicates (ii) before semantically clustering images based on the tweets in which they were originally posted. Using this approach, we were able to achieve over 50% precision for images in the top 5 ranks. In the second retrieval scenario, we show that by combining contextual and content-based features from images, we are able to predict if it will become “popular” (or not) with 74% accuracy, using an SVM classifier. Finally, in chapter 9 we employ blur detection and perceptual-hash clustering in order to remove noisy images from lifelogs, before combining visual and geo-temporal signals in order to capture a user’s “key moments” within their day. We believe that the results of this thesis show an important step towards building effective image retrieval models when there lacks sufficient textual content (i.e. a cold start).