Tumour markers as prognostic factors of survival of gastric cancer patients

The incidence of gastric cancer in the last decades has declined rapidly in the industrialised countries. Worldwide, however, gastric cancer is still the second most common cause of cancer death. Although surgery is currently the most effective treatment, the rapid progress in adjuvant chemotherapy and radiation therapy requires a re-evaluation of prognosis assessment. The TNM staging system of the UICC is ubiquitously used; it groups patients by decreasing survival times from stage I to stage IV based on the spread of disease, i.e. depth of tumour penetration (T), extent of spread to lymph nodes (N), and the presence or absence of distant (M) metastases. This is by far the most consistent prognostic classification system today. However, even within the stage groups there are patients that follow a varying course of disease. Our knowledge of the molecular differences between tumours of the same stage and morphology has been accumulating over the years and methods for a more accurate assessment of the phenotype of neoplasias are of value when evaluating the prognosis of individual patients with gastric cancer. In this study, the immunohistochemical expression of tumour markers involved in different phases in tumourigenesis was examined. The aim was to find new markers which could provide prognostic information in addition to what is provided by the TNM variables. A total of 337 specimens from the primary tumour of patients who underwent surgery for gastric cancer were collected and the immunohistochemical expression of seven different biomarkers was analysed. DNA ploidy and S-phase fraction (SPF) was assessed by flow cytometry. Finally, all biomarkers and clinicopathological prognostic factors were combined and evaluated by a multivariate Cox regression model to elucidate which specific factors provide independent prognostic information. By univariate survival analysis the following variables were significant prognostic factors: epithelial and stromal syndecan-1 expression, stromal tenascin-C expression, expression of tumour-associated trypsin inhibitor (TATI) in cancer cells, nuclear p53 expression, nuclear p21 expression, DNA ploidy, and SPF. By multivariate survival analysis adjusted for all available clinicopathological and biomolecular variables, p53 expression, p21 expression, and DNA ploidy emerged as independent prognostic biomarkers, together with penetration depth of the tumour, presence of nodal metastases, surgical cure of the cancer, and age of the patient at the time of diagnosis.

Gastric motility: Measurement, symptoms and therapy

Gastric motility disorders, including delayed gastric emptying (gastroparesis), impaired postprandial fundic relaxation, and gastric myoelectrical disorders, can occur in type 1 diabetes, chronic renal failure, and functional dyspepsia (FD). Symptoms like upper abdominal pain, early satiation, bloating, nausea and vomiting may be related to gastroparesis. Diabetic gastroparesis is related to autonomic neuropathy. Scintigraphy is the gold standard in measuring gastric emptying, but it is expensive, requires specific equipment, and exposes patients to radiation. It also gives information about the intragastric distribution of the test meal. The 13C-octanoic acid breath test (OBT) is an alternative, indirect method of measuring gastric emptying with a stable isotope. Electrogastrography (EGG) registers the slow wave originating in the pacemaker area of the stomach and regulating the peristaltic contractions of the antrum. This study compares these three methods of measuring gastric motility in patients with type 1 diabetes, functional dyspepsia, and chronic renal failure. Currently no effective drugs for treating gastric motility disorders are available. We studied the effect of nizatidine on gastric emptying, because in preliminary studies this drug has proven to have a prokinetic effect due to its cholinergic properties. Of the type 1 patients, 26% had delayed gastric emptying of solids as measured by scintigraphy. Abnormal intragastric distribution of the test meal occurred in 37% of the patients, indicating impaired fundic relaxation. The autonomic neuropathy score correlated positively with the gastric emptying rate of solids (P = 0.006), but HbA1C, plasma glucose levels, or abdominal symptoms were unrelated to gastric emptying or intragastric distribution of the test meal. Gastric emptying of both solids and liquids was normal in all FD patients but abnormal intragastric distribution occurred in 38% of the patients. Nizatidine improved symptom scores and quality of life in FD patients, but not significantly. Instead of enhancing, nizatidine slowed gastric emptying in FD patients (P < 0.05). No significant difference appeared in the frequency of the gastric slow waves measured by EGG in the patients and controls. The correlation between gastric half-emptying times of solids measured by scintigraphy and OBT was poor both in type 1 diabetes and FD patients. According to this study, dynamic dual-tracer scintigraphy is more accurate than OBT or EGG in measuring gastric emptying of solids. Additionally it provides information about gastric emptying of liquids and the intragastric distribution of the ingested test meal.

HER2 positive gastric and gastroesophageal adenocarcinoma; An Irish tertiary center experience

Background: Trastuzumab has been approved for patients with human epidermal growth factor receptor 2 (HER2) over expression and gene amplification metastatic gastric cancer. Here we present the prevalence of HER2 positive gastric cancer in an Irish population, the use of Trastuzumab in first line and beyond progression. Methods: The study was conducted in St James's Hospital, Dublin. A retrospective analysis of the date of patients with HER2 positive gastric cancer over a period of 3 years was carried out. Her2 positive was defined as immunohistochemistry (IHC) score of +3, of IHC score of +2 and increased gene copy number by fluorescence in situ hybridization (FISH). Overall survival was calculated from the day of initiation of treatment with Trastuzumab until death. Results: During the study period 140 patients with gastric and gastro-esophageal junction adenocarcinoma were treated. Out of those, 30 (21.4%) had HER2 positive disease. Among HER2 positive disease patients 18 (12.8%) were treated with first line Trastuzumab containing regimen with a median overall survival of 13 months. Nine (50%) developed progressive disease while on Trastuzumab and of those, 4 (22.2%) patients continued on Trastuzumab beyond progression, two (11.1%) of whom achieved stable disease and a prolonged survival. Conclusion: HER2 positivity rate in an Irish population with advanced gastric and gastro-esophageal junction adenocarcinoma is 21.4%. Treatment with Trastuzumab in the first line in combination with chemotherapy is a reasonable approach. Continuation of Trastuzumab beyond progression is a feasible strategy that requires further exploration.

Prognostic significance of cyclooxygenase-2 and associated molecules in gastric cancer

Background and aims: Low stage and curative surgery are established factors for improved survival in gastric cancer. However, not all low-stage patients have a good prognosis. Cyclooxygenase-2 (COX-2) is known to associate with reduced survival in several cancers, and has been shown to play an important role in gastric carcinogenesis. Since new and better prognostic markers are needed for gastric cancer, we studied the prognostic significance of COX-2 and of markers that associate with COX-2 expression. We also studied markers reflecting proliferation and apoptosis, and evaluated their association with COX-2. Our purpose was to construct an accurate prognostic model by combining tissue markers and clinicopathogical factors. Materials and methods: Of 342 consecutive patients who underwent surgery for gastric cancer at Meilahti Hospital, Helsinki University Central Hospital, 337 were included in this study. Low stages I to II were represented by 141 (42%) patients, and high stages III to IV by 196 (58%). Curative surgery was performed on 176 (52%) patients. Survival data were obtained from the national registers. Slides from archive tissue blocks were prepared for immunohistochemistry by use of COX-2, human antigen R (HuR), cyclin A, matrix metalloproteinases 2 and 9 (MMP-2, MMP-9), and Ki-67 antibodies. Immunostainings were scored by microscopy, and scores were entered into a database. Associations of tumor markers with clinicopathological factors were calculated, as well as associations with p53, p21, and results of flow cytometry from earlier studies. Survival analysis was performed by the Kaplan-Meier method, and Cox multivariate models were reconstructed. Cell culture experiments were performed to explore the effect of small interfering (si)RNA of HuR on COX-2 expression in a TMK-1 gastric cancer cell line. Results: Overall 5-year survival was 35.1%. Study I showed that COX-2 was an independent prognostic factor, and that the prognostic impact of COX-2 was more pronounced in low-stage patients. Cytoplasmic HuR expression also associated with reduced survival in gastric cancer patients in a non-independent manner. Cell culture experiments showed that HuR can regulate COX-2 expression in TMK-1 cells in vitro, with an association also between COX-2 and HuR tissue expression in a clinical material. In Study II, cyclin A was an independent prognostic factor and was associated with HuR expression in the gastric cancer material. The results of Study III showed that epithelial MMP-2 associated with survival in univariate, but not in multivariate analysis. However, MMP-9 showed no prognostic value. MMP-2 expression was associated with COX-2 expression. In Study IV, the prognostic power of COX-2 was compared with that of all tested markers associated with survival in Studies I to III, as well as with p21, p53, and flow cytometry results. COX-2 and p53 were independent prognostic factors, and COX-2 expression was associated with that of p53 and Ki-67 and also with aneuploidy. Conclusions: COX-2 is an independent prognostic factor in gastric cancer, and its prognostic power emerges especially in low stage cancer. COX-2 is regulated by HuR, and is associated with factors reflecting invasion, proliferation, and apoptosis. In an extended multivariate model, COX-2 retained its position as an independent prognosticator. COX-2 can be considered a promising new prognostic marker in gastric cancer.

Mixed-mode stress intensity factors for arbitrarily oriented cracks in cylindrical shells under axial pull and torsion

Results of photoelastic investigations conducted on cylindrical tubes (made of Araldite material) containing cracks oriented at 0°, 30°, 45°, 60° and 90° to the axis of the tube and subjected to axial and torsional loads are reported. The stress-intensity factors (SIFs) were determined by analysing the crack-tip stress fields. Smith and Smith's method [Engng Fracture Mech.4, 357–366 (1972)] and a new method developed by the authors by modifying Rakesh et al.'s method [Proc. 26th Congress of ISTAM, India (1981)] were employed to evaluate the mixed-mode SIFs.

Bond length distortions associated with torsion potentials; ab-initio studies on methanedio

The 4-31G basis set is used to study the bond length variations as functions of dihedral angels in methanediol. This study is compared with O---C---O bond angle optimization studies by Gorenstein and Kar and the possible reason for bond length shorteing in the trans---trans configuration is analysed.

Influence of state of stress on the processing map for hot working of stainless steel type AISI 304L: compression vs. torsion

Processing maps for hot working of stainless steel of type AISI 304L have been developed on the basis of the flow stress data generated by compression and torsion in the temperature range 600–1200 °C and strain rate range 0.1–100 s−1. The efficiency of power dissipation given by 2m/(m+1) where m is the strain rate sensitivity is plotted as a function of temperature and strain rate to obtain a processing map, which is interpreted on the basis of the Dynamic Materials Model. The maps obtained by compression as well as torsion exhibited a domain of dynamic recrystallization with its peak efficiency occurring at 1200 °C and 0.1 s−1. These are the optimum hot-working parameters which may be obtained by either of the test techniques. The peak efficiency for the dynamic recrystallization is apparently higher (64%) than that obtained in constant-true-strain-rate compression (41%) and the difference in explained on the basis of strain rate variations occurring across the section of solid torsion bar. A region of flow instability has occurred at lower temperatures (below 1000 °C) and higher strain rates (above 1 s−1) and is wider in torsion than in compression. To achieve complete microstructure control in a component, the state of stress will have to be considered.

A new theory of gravitation with parity-violating propagating torsion

A new theory of gravitation has been proposed in a more general space-time than Riemannian. It is a generalization of the ECSK and Brans-Dicke (BD) theory of gravitation. It is found that, in contrast to the standard the ECSK theory, a parity-violating propagating torsion is generated by the BD scalar field. The interesting consequence of the theory is that it can successfully predict solar system experimental results to desired accuracy.

Flap-lag-torsion stability in hover and forward flight with three-dimensional wake

The contributions of full-wake dynamics in trim analysis are demonstrated for finding the control inputs and periodic responses simultaneously, as well as in Floquet eigenanalysis for finding the damping levels. The equations of flap bending, lag bending, and torsion are coupled with a three-dimensional, finite state wake, and low-frequency (<1/rev) to high frequency (>1/rev) multiblade modes are considered. Full blade-wake dynamics is used in trim analysis and Floquet eigenanalysis. A uniform cantilever blade in trimmed flight is investigated over a range of thrust levels, advance ratios, number of blades, and blade torsional frequencies. The investigation includes the convergence characteristics of control inputs, periodic responses, and damping levels with respect to the number of spatial azimuthal harmonics and radial shape functions in the wake representation. It also includes correlation with the measured lag damping of a three-bladed untrimmed rotor. The parametric study shows the dominant influence of wake dynamics on control inputs, periodic responses, and damping levels, and wake theory generally improves the correlation.

Deformation behaviour of Titanium in torsion

The evolution of microstructure and texture in Hexagonal Close Pack commercially pure titanium has been studied in torsion in a strain rate regime of 0.001 to 1 s(-1). Free end torsion tests carried out on titanium rods indicated higher stress levels at higher strain rate but negligible change in the strain-hardening behaviour. There was a decrease in the intra-granular misorientation while a negligible change in the amount of contraction and extension twins was observed with increase in strain rate. The deformed samples showed a C-1 fibre (c-axis is first rotated 90 degrees in shear direction and then +30 degrees in shear plane direction) at all the strain rates. With the increase in strain rate, there was an increase in the intensity of the C-1 fibre and it became more heterogeneous with a strong {11(2)over-bar6}< 2(8)over-bar)63 > component. In the absence of extensive twinning, pyramidal < c+a > slip system is attributed for the observed deformation texture. The present investigation, therefore, substantiates the theoretical prediction of increase in strength of texture with strain rate in torsion.

Coupled polynomial field approach for elimination of flexure and torsion locking phenomena in the Timoshenko and Euler-Bernoulli curved beam elements

The curvature related locking phenomena in the out-of-plane deformation of Timoshenko and Euler-Bernoulli curved beam elements are demonstrated and a novel approach is proposed to circumvent them. Both flexure and Torsion locking phenomena are noticed in Timoshenko beam and torsion locking phenomenon alone in Euler-Bernoulli beam. Two locking-free curved beam finite element models are developed using coupled polynomial displacement field interpolations to eliminate these locking effects. The coupled polynomial interpolation fields are derived independently for Timoshenko and Euler-Bernoulli beam elements using the governing equations. The presented of penalty terms in the couple displacement fields incorporates the flexure-torsion coupling and flexure-shear coupling effects in an approximate manner and produce no spurious constraints in the extreme geometric limits of flexure, torsion and shear stiffness. the proposed couple polynomial finite element models, as special cases, reduce to the conventional Timoshenko beam element and Euler-Bernoulli beam element, respectively. These models are shown to perform consistently over a wide range of flexure-to-shear (EI/GA) and flexure-to-torsion (EI/GJ) stiffness ratios and are inherently devoid of flexure, torsion and shear locking phenomena. The efficacy, accuracy and reliability of the proposed models to straight and curved beam applications are demonstrated through numerical examples. (C) 2012 Elsevier B.V. All rights reserved.

Radial Deformation of Cylinders Due to Torsion

Classical literature on solid mechanics claims existence of radial deformation due to torsion but there is hardly any literature on analytic solutions capturing this phenomenon. This paper tries to solve this problem in an asymptotic sense using the variational asymptotic method (VAM). The method makes no ad hoc assumptions and hence asymptotic correctness is assured. The VAM splits the 3D elasticity problem into two parts: A 1D problem along the length of the cylinder which gives the twist and a 2D cross-sectional problem which gives the radial deformation. This enables closed form solutions, even for some complex problems. Starting with a hollow cylinder, made up of orthotropic but transversely isotropic material, the 3D problem has been formulated and solved analytically despite the presence of geometric nonlinearity. The general results have been specialized for particularly useful cases, such as solid cylinders and/or cylinders with isotropic material. DOI: 10.1115/1.4006803]