There is increasing evidence that the presence of a systemic inflammatory response plays an important role in predicting survival in patients with colorectal cancer. However, it is not clear what components of the systemic inflammatory response best predict survival. The aim of the present study was to compare the prognostic value of an inflammation-based prognostic score (modified Glasgow Prognostic Score (Mgps) 0 ¼ C-reactive protein o10 mg l À1 , 1 ¼ C-reactive protein 410 mg l À1 , and 2 ¼ C-reactive protein 410 mg l À1 and albumino35 g l À1 ) with that of components of the white cell count (neutrophils, lymphocytes, monocytes and platelets using standard thresholds) in patients with colorectal cancer. Two patient groups were studied: 149 patients who underwent potentially curative resection for colorectal cancer and 84 patients who had synchronous unresectable liver metastases. In those patients who underwent potentially curative resection the minimum follow-up was 36 months and 20 patients died of their cancer. On multivariate survival analysis only TNM stage (HR 3.75, 95% CI 1.54 -9.17, P ¼ 0.004), monocyte count (HR 3.79, 95% CI 1.29 -11.12, P ¼ 0.015) and mGPS (HR 2.21, 95% CI 1.11 -4.41, P ¼ 0.024) were independently associated with cancer-specific survival. In patients with synchronous unresectable liver metastases the minimum follow-up was 6 months and 71 patients died of their cancer. On multivariate survival analysis only single liver metastasis 45 cm (HR 1.78, 95% CI 0.99 -3.21, P ¼ 0.054), extrahepatic disease (HR 2.09, 95% CI 1.05 -4.17, P ¼ 0.036), chemotherapy treatment (HR 2.40, 95% CI 1.82 -3.17, Po0.001) and mGPS (HR 1.44, 95% CI 1.01 -2.04, P ¼ 0.043) were independently associated with cancer-specific survival. In summary, markers of the systemic inflammatory response are associated with poor outcome in patients with either primary operable or synchronous unresectable colorectal cancer. An acute-phase protein-based prognostic score, the mGPS, appears to be a superior predictor of survival compared with the cellular components of the systemic inflammatory response.

The study described in this paper investigates the combined effect of certain variables on student achievement in classical mechanics. Our purposes are (1) to describe the preinstructional knowledge of mechanics, mathematical skills, and reasoning skills of a sample of college physics students, (2) to correlate these variables with the student’s success in learning classical mechanics, and (3) to develop an hypothesis about the relationships between these variables and student achievement in mechanics. We also offer some proposals for improving the teaching of classical mechanics.

Spinocerebellar ataxia type 6 (SCA6) was recently identified as a form of autosomal dominant cerebellar ataxia associated with small expansions of the trinucleotide repeat (CAG)n in the gene CACNL1A4 on chromosome 19p13, which encodes the alpha1 subunit of a P/Q-type voltage-gated calcium channel. We describe clinical, genetic, neuroimaging, neuropathological, and quantitative oculomotor studies in four kindreds with SCA6. We found strong genetic linkage of the disease to the CACNL1A4 locus and strong association with the expanded (CAG)n alleles in two large ataxia kindreds. The expanded alleles were all of a single size (repeat number) within the two large kindreds, numbering 22 and 23 repeat units. It is noteworthy that the age of onset of ataxia ranged from 24 to 63 years among all affected individuals, despite the uniform repeat number. Radiographically and pathologically, there was selective atrophy of the cerebellum and extensive loss of Purkinje cells in the cerebellar cortex. In addition, clinical and quantitative measurement of extraocular movements demonstrated a characteristic pattern of ocular motor and vestibular abnormalities, including horizontal and vertical nystagmus and an abnormal vestibulo-ocular reflex. These studies identify a distinct phenotype associated with this newly recognized form of dominant SCA.

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