A new simplified comorbidity score as a prognostic factor in non-small-cell lung cancer patients: description and comparison with the Charlson's index

Treatment of non-small-cell lung cancer (NSCLC) might take into account comorbidities as an important variable. The aim of this study was to generate a new simplified comorbidity score (SCS) and to determine whether or not it improves the possibility of predicting prognosis of NSCLC patients. A two-step methodology was used. Step 1: An SCS was developed and its prognostic value was compared with classical prognostic determinants in the outcome of 735 previously untreated NSCLC patients. Step 2: the SCS reliability as a prognostic determinant was tested in a different population of 136 prospectively accrued NSCLC patients with a formal comparison between SCS and the classical Charlson comorbidity index (CCI). Prognosis was analysed using both univariate and multivariate (Cox model) statistics. The SCS summarised the following variables: tobacco consumption, diabetes mellitus and renal insufficiency (respective weightings 7, 5 and 4), respiratory, neoplastic and cardiovascular comorbidities and alcoholism (weighting=1 for each item). In step 1, aside from classical variables such as age, stage of the disease and performance status, SCS was a statistically significant prognostic variable in univariate analyses. In the Cox model weight loss, stage grouping, performance status and SCS were independent determinants of a poor outcome. There was a trend towards statistical significance for age (P=0.08) and leucocytes count (P=0.06). In Step 2, both SCS and well-known prognostic variables were found as significant determinants in univariate analyses. There was a trend towards a negative prognostic effect for CCI. In multivariate analysis, stage grouping, performance status, histology, leucocytes, lymphocytes, lactate dehydrogenase, CYFRA 21-1 and SCS were independent determinants of a poor prognosis. CCI was removed from the Cox model. In conclusion, the SCS, constructed as an independent prognostic factor in a large NSCLC patient population, is validated in another prospective population and appears more informative than the CCI in predicting NSCLC patient outcome

Analysis of the oligomeric requirement for signaling by CD40 using soluble multimeric forms of its ligand, CD154

We describe the construction of a novel soluble dodecameric form of CD154 (CD40 ligand) that is more effective than trimeric tCD154 in triggering B cell activation. Dodecameric surfactant protein (SP)-D-CD154 was more potent than tCD154 in inducing B cell proliferation over a wide range of concentrations. At saturating concentrations, the level of proliferation triggered by SP-D-CD154 was fourfold higher than that achieved with tCD154. Moreover, stimulation with dodecameric CD154 induced higher levels of the costimulatory molecules ICAM-1 and CD86. The higher activity of dodecameric CD154 when compared to trimeric CD154 is unlikely to be due to differences in their avidity for CD40, since both forms bound to CD40 strongly. Therefore, the extent of receptor clustering directlyregulates signaling by CD40

The Evolution of Marketing as an Innovative Knowledge Stream: The Evolving Role of Stakeholder Causal Scope

The aim of this chapter is to discuss the evolution of marketing as a field of practice and academic discipline, the different eras of its evolution and relevant market factors and competitive factors to reinforce our perceptions of the advances of marketing dynamics that extend competitive advantage and ensure business sustainability. An inductive constructivist approach is followed to support findings from the reviewed literature. These illustrate six eras in the evolution of marketing and recommend an analysis of the causes and consequences of stakeholder relationships and interactions as a stakeholder causal scope of strategic market/stakeholder orientation, as an alternative approach to building capacity in dealing with the contemporary competitive markets, with an aim to prolong competitive advantage

Comparative analysis of the 1-mile run test evaluation formulae: Assessment of aerobic capacity in male law enforcement officers aged 20-23 years

The purpose of this study was to compare values of aerobic performance in the 1-mile run test (1-MRT) using different formulae. Aerobic capacities of 351 male volunteers working for the Turkish National Police within the age range of 20-23 years were evaluated by the 1-MRT and the 20-metre shuttle run (20-MST). VO(2max)values were estimated by the prediction equations developed by George et al. (1993), Cureton et al. (1995) and Kline et al. (1987) for the 1-MRT and by Leger and Lambert (1982) for the 20-MST. The difference between the results of the different formulae was significant (p = 0.000). The correlation coefficient between the estimated VO2max using Cureton's equation, George's equation, Kline's equation and the 20-MST were 0.691 (p < 0.001), 0.486 (p < 0.001) and 0.608 (p < 0.001), respectively. The highest correlation coefficient was between the VO2max estimated by the 20-MST and Cureton's equation. Similarly, the highest correlation coefficient (r = -0.779) was between the 1-mile run time and the VO2max estimated by Cureton's equation. When analysing more vigorous exercise than sub-maximal exercise, we suggest that Cureton's equation be used to predict the VO2max from 1-mile run/walk performance in large numbers of healthy individuals with high VO2max. This research compares the use of 3 different formulae to estimate VO2max from 1-mile run/walk performance in male law enforcement officers aged 20-23 years for the first time and reports the most accurate formula to use when evaluating aerobic capacities of large numbers of healthy individuals