IN THE NEWS: Anneliese McConnell, 2022 Year 4 MD Project student research feature on ABC News

PUBLISHED RESEARCH: Michelle Luk, 2023 Year 4 MD Project student published research report

Young people's experiences of the Northern Rivers 2017 flood and its effects on their mental health

Michelle Luk, Jo Longman 

Published 8 March 2024

Abstract

Objective: To explore young people's (YP) experiences of catastrophic flooding in the Northern Rivers area of northern NSW in 2017 and its effect on their mental health.

Design: Content analysis of free-text survey responses (written responses to open questions, rather than selecting a response option).

Setting: Northern Rivers NSW.

Participants: YP aged 16–25 years who were Northern Rivers residents at the time of the 2017 flood.

Results: YP found their flood experience to be novel and challenging. They expressed worry, distress, anxiety, and worsened pre-existing mental health issues as a result of the flood. YP reported a number of primary stressors (inadequate preparedness, warning and support during the flood) and secondary stressors (loss/ damage of property and possessions, financial strain and disruptions to daily life) which potentially contributed to poor mental health. Some YP reported positive outcomes from their flood experience, notably increased community connectedness and personal resilience. However, they also expressed concern for the future, particularly potential reoccurrence of extreme floods as well as climate change. YP conveyed a desire for better community involvement to improve preparedness for future floods and a clear motivation to take action on climate change.

Conclusion: The flood was a challenging experience for YP which was commonly described as negatively affecting their mental health. Understanding what YP view as significant events or issues arising from their personal flood experience may help target support mechanisms and services to maintain their mental. More focus on community-based initiatives to improve disaster preparedness can support mental health in YP.

KEYWORDS Australia, extreme weather, flood, mental health, natural disaster, rural health, young adult

PUBLISHED RESEARCH: Lucinda Colbert, 2023 Year 4 MD Project student published research report

Medical Students' Awareness of Overdiagnosis and Implications for Preventing Overdiagnosis

Lucinda Colbert, Iman Hegazi, Kath Peters and Natalie Edmiston

Published 8 March 2024

Abstract: Overdiagnosis is a growing health issue, yet our understanding of medical students’ exposure to this concept within medical education is limited. Our aim was to explore students’ experience of diagnostic learning to identify how overdiagnosis may be understood by students. During in-person and online semi-structured interviews throughout 2021, we explored the education experience of twelve Western Sydney University medical students in years 3–5. Through inductive thematic analysis we identified four themes. These themes encompassed student commitment to learning about diagnosis, lack of certainty surrounding diagnosis and emotional factors of medical care, overdiagnosis as seen through the lens of high and low-value care during clinical placements and student-identified missed learning opportunities related to overdiagnosis. This study found that medical students develop inherent knowledge of overdiagnosis through an interplay of personal factors, medical school curriculum and the setting in which their training takes place. Our findings allow insight for future improvement of medical curriculum to produce exceptional medical graduates.

Congratulations to Year 5, 2023 student, Dharmesh Sharma, Overall Winner of the School of Medicine's 2023 3+1Q Student Research Competition

On Monday, 30 October 2023, the event showcased a high level of wide-ranging student  research engagement and Dharmesh presented, via Zoom, on his MD Project topic "Clinical Outcomes of Upper Gastrointestinal Cancer Resection".  Presenting the winning talk, Dharmesh also won the People's Choice Award.

We wish Dharmesh well as he represents WSU at the Medical Deans Australia and New Zealand Medical School 3+1Q Competition in November 2023.

CONFERENCE SPEAKER: Josephine Canceri, 2022 Year 4 MDP student, presenting at the 2023 WONCA World Conference in Sydney

Presented 26-29 October 2023

CONFERENCE SPEAKER: Lucinda Colbert, 2022 Year 4 MDP student, presenting at the Rural Medicine Australia Conference 2023

Presented 18-21 October 2023

PUBLISHED RESEARCH: Timothy Choi, 2022 Year 4 MD Project student published research report

Impact of multidisciplinary care of diabetic foot infections for inpatients at Campbelltown Hospital

Timothy Choi, Uchechukwu Levi Osuagwu, Chau Tran,  Krupali Bulsari and David Simmons

Published 19 October 2023

Background: Diabetic foot infection (DFI), including diabetic foot ulcer, is a serious complication of diabetes, particularly in the South Western Sydney (SWS) region where it is a leading cause of diabetes-related hospitalisations. Multidisciplinary team (MDT) involvement is effective at improving the health outcomes of DFI patients. This study investigated the impact of MDT (High Risk Foot Service, HRFS) on the length of stay and surgical outcomes of inpatients with DFI in a Sydney tertiary hospital.

Method: A retrospective audit of electronic medical records of inpatient admissions for DFI at Campbelltown Hospital between January 2019 - December 2021, was performed. The main outcome of the study was MDT involvement, defined as having two or more specialities involved in the patient’s treatment. The other measured variables included length of stay (defined as the total duration from admission to discharge), and surgical outcomes including debridement, minor amputation, and major amputation.

PUBLISHED RESEARCH: MBBS Students -  Tran M, Kim R, Alrefae A, Ryu S, Teh J

E-Prescription: Views and Acceptance of General Practitioners and Pharmacists in Greater Sydney

Phyllis Lau, Minh Thuan Tran, Ricky Yong Kim, Alsayed Hashem Alrefae, Sangwoo Ryu and Jim Chyuan Teh

Published 15 September 2023

Background: Electronic prescription (e-prescription) was introduced in 2020 in Australia during the COVID-19 pandemic. This research aimed to explore general practitioners (GPs) and community pharmacists’ experience with, and facilitators and barriers to, the use of e-prescription.

POSTER PRESENTATION: Dongchan Kim and Timothy Choi 2023 Year 5 students presenting at the Australasian Diabetes Congress in August 2023

Prevalence of Metabolic-Associated Fatty Liver Disease and Screening for Liver Fibrosis in Type 2 Diabetes Mellitus

Presented August 2023

Impact of Multidisciplinary Care of Diabetec Foot Inpatients in Campbelltown Hospital

Presented August 2023

CONFERENCE SPEAKER: Michael Casten, 2022 Year 4 student presenting at the International AIDS Society Conference on 16-23 July 2023

What are the Predictors of Change in Multimorbidity Among People with HIV? A Longitudinal Observational Cohort Study

Click on the poster below to listen to Michael Casten's presentation.

CONFERENCE SPEAKER: Lucinda Colbert, 2022 Year 4 student, presenting at the Australia and New Zealand Association for Health Professional Educators

Diagnosis and Overdiagnosis in the Medical Curriculum

Presented  26-29 June 2023

Listen to  Dr Natalie Edmiston, Senior Lecturer, Rural Research, Lismore presenting on this topic in August 2023 on The BMJ Podcast (fast forward to the last 7 minutes where Dr Edmiston is featured).

REPORT: 2022 ANZ  Research Educators Network 3+1Q Competition

PUBLISHED RESEARCH: Patrick Low 2023 Year 4 MD Project student published research report

Determining  Efficacy of Dynamic Multimedia Bowel Preparation Instructions Versus Standard Instructions on Adenoma Detection and Patient Reported Measures (DIGICLEAN Trial): a Study Protocol for a Multicentre, Colonoscopist-Blinded, Randomised Controlled Trial

Michal Au, Patrick Low, Michael Rennie, Marriam Mohseni, Yang Song, Narae Kim, Brandon Baraty, Nikola Mitrev, Emily He, Vincent Ho, Rupert Leong, Viraj Kariyawasam

Published 08 June 2023

PUBLISHED RESEARCH: Lachlan Gregory, 2022 Year 4 MD Project student published research report

Does Social Media Usage Ameliorate Loneliness in Rural Youth? A Cross Sectional Pilot Study

Lachlan Gregory, Tegan Dutton, Uchechukwu Levi Osuagwu and Robyn Vines

Published 26 May 2023

Aim
To invesitgate the relationship between social media use and loneliness and psychological wellbeing of youth in rural New South Wales.

Design
Design This was a web-based cross-sectional survey.

Methods
The survey consisted of 33 items including demography (12 items), participants’ social media use (9
items), mood and anxiety (6 items), perceived loneliness (6 items), the impact of COVID-19 on social media usage or
perceived loneliness (2 items). The participants’ mood and anxiety were evaluated using the psychological distress
tool (K6), while loneliness was measured using the De Jong Gierveld 6-item scale. Total loneliness and psychological
distress scores were compared between demographic variables.

Results
A total of 47 participants, aged 16–24 years took part in the study. The majority were women (68%) and
many had K6 score that was indicative of psychological distress (68%). About half of the participants indicated that
Facebook (FB) was their most used social media platform and two in five participants were on social media within
10 min of waking up each day, about 30% spent more than 20 h per week on social media, and more than two-third
sent private messages, images, or videos, multiple times a day. The mean loneliness score was 2.89 (range, 0 to 6), with
0 being ‘not lonely’ and 6 being ‘intense social loneliness’. One-way ANOVA and χ2 test results showed that those who
used FB most frequently had significantly higher mean scores for loneliness compared to those that used other social
media platforms (p = 0.015). Linear regression analysis revealed that those who commonly used FB were more likely
to report higher loneliness scores (coefficient = –1.45, 95%CI –2.63, –0.28, p = 0.017), while gender (p = 0.039), age
(p = 0.048), household composition (p = 0.023), and education level (p = 0.014) were associated with severe psychological
distress.

Conclusions
The study found that social media usage, particularly FB, as measured by time used and active or passive
engagement with the medium, was significantly linked to loneliness, with some impact on psychological distress.
Social media use within ten minutes of waking increased the likelihood of psychological distress. However, neither
loneliness nor psychological distress were associated with rurality among the rural youth in this study.

PUBLISHED RESEARCH: Vrinda Jain and Phillip Liang 2022 Year 4 MD Project students published research report

Light Activation of the Dopaminergic System Occurs After Eye-Opening in the Mouse Retina

Vrinda Jain, Phillip Liang, Sushmitha Raja, Meena Mikhael and Morven Cameron

Published 09 May 2023

The neuromodulator dopamine plays a significant role in light adaptation, eye growth, and modulation of neuronal circuitry in the retina. Dopaminergic amacrine cells in the adult retina release dopamine in response to light stimulation, however, the light-induced activity of these cells in during postnatal development is not known. We assessed the activity of dopaminergic amacrine cells in the retina response to a light pulse in C57BL/6 wild-type animals across various postnatal ages. Expression of tyrosine hydroxylase (TH) in dopaminergic amacrine cells was apparent from postnatal day 3 (P3) and restricted to the dorso-temporal region; by P8 TH+ cells were uniformly distributed across the retina. TH cell density increased until P8 and then markedly decreased by P10 to then remain at this density into adulthood. Light-induced c-fos expression was observed in all light-pulsed retinae, however, no c-fos was ever found to be co-localised with TH prior to P12. At P14, one day after eye opening, 100% of TH cells co-localised with c-fos and this was maintained for all older ages analysed. Dopamine and its primary metabolite DOPAC were measured in the vitreous of animals P8-P30. Both analytes were found in the vitreous at all ages, however, a significant difference in dopamine concentration between dark and light-pulsed animals was only observed at P30. DOPAC concentration was found to be significantly light-induced from P16, and the amplitude of this difference increased over time. Our data suggests that dopaminergic cell activation and light-induced dopamine release in the retina is primarily driven by classical photoreceptors after eye-opening.

PUBLISHED RESEARCH: Shakthi Elangovan, 2022 Year 4 MD Project student published research report

Antibacterial Properties of Eucalyptus globulus Essential Oil against MRSA: A Systematic Review

Shakthi Elangovan and Poonam Mudgil

Published 27 February 2023

Abstract: Antimicrobial resistance is a huge threat against the public health sphere and is a major cause of global mortality and morbidity. Antibiotic misuse and overuse have led to the development of many resistant bacterial strains. One particular bacterium of concern is methicillin-resistant Staphylococcus aureus (MRSA), which is the most common resistant bacteria in humans. Antibiotic development has been unable to keep up with the rapid evolution of antibiotic-resistant organisms, and there is an urgent need to identify alternative agents to combat this problem. The purpose of this systematic review is to explore the literature on the antibacterial properties of Eucalyptus globulus essential oil against MRSA. The articles used in this review were obtained through a systematic search of the literature across four databases, with the timeline being between 2002 and 2022. Twenty studies were included in this review, which used various methods to investigate the antibacterial properties of E. globulus essential oil, alone or in combination with other agents, against MRSA. The findings suggest that E. globulus essential oil has antibacterial properties against MRSA, which can be enhanced when used in combination with other agents, such as other essential oils and antibiotics.

PUBLISHED RESEARCH: Michael Casten, 2022 Year 4 MD Project student published research report

What are the Predictors of Change in Multimorbidity Among People with HIV? A Longitudinal Observational Cohort Study

Published  27 February 2023

Abstract

Introduction: Multimorbidity is common among people living with HIV (PLWH), with numerous cross-sectional studies demonstrating associations with older age and past immunosuppression. Little is known about the progression of multimorbidity, particularly in the setting of long-term access to antiretrovirals. This study aims to determine factors predictive of change in multimorbidity in PLWH.

Methods: People living with HIV who attended a regional HIV service were recruited to a consented observational cohort between September 2016 and March 2020. Demographic data, laboratory results and a Cumulative Illness Rating Scale (CIRS) were collected at enrolment and first clinical review of every subsequent year. Change in CIRS score was calculated from enrolment to February 2021. Associations with change were determined through univariate and multivariate linear regression.

Results: Of 253 people, median age was 58.9 [interquartile range (IQR): 51.9–64.4] years, 91.3% were male, and HIV was diagnosed a median of 22.16 years (IQR: 12.1–30.9) beforehand. Length of time in the study was a median of 134 weeks (IQR: 89.0–179.0), in which a mean CIRS score change of 1.21 (SD 2.60) was observed. Being older (p < 0.001) and having a higher body mass index (p = 0.008) and diabetes (p = 0.014) were associated with an increased likelihood of worsening multimorbidity. PLWH with a higher level of multimorbidity at baseline were less likely to worsen over time (p < 0.001).

Conclusion: As diabetes and weight predict worsening multimorbidity, routine diabetes screening, body mass index measurement, and multimorbidity status awareness are recommended.

POSTER PRESENTATION: Ernestene Yao 2022 Year 4 student poster presentation at the ESA/SRB/APEG/NZSE Annual Scientific Meeting

Presented 13 November 2022

PUBLISHED RESEARCH: Kathryn Chen, 2022 Year 3 MD Project student published research report

Chondroitin Sulfate Proteoglycan 4 as a Marker for Aggressive Squamous Cell Carcinoma

Kathryn Chen, Joel Yong, Roland Zauner, Verena Wally, John Whitelock, Mila Sajinovic, Zlatko Kopecki, Kang Liang, Kieran Francis Scott and Albert Sleiman Mellick

Published  13 November 2022

Abstract: Chondroitin sulfate (CS) proteoglycan 4 (CSPG4) is a cell surface proteoglycan that is currently under investigation as a marker of cancer malignancy, and as a potential target of anticancer drug treatment. CSPG4 acts as a driver of tumourigenesis by regulating turnover of the extracellular matrix (ECM) to promote tumour cell invasion, migration as well as inflammation and angiogenesis. While CSPG4 has been widely studied in certain malignancies, such as melanoma, evidence is emerging from global gene expression studies, which suggests a role for CSPG4 in squamous cell carcinoma (SCC). While relatively treatable, lack of widely agreed upon diagnostic markers for SCCs is problematic, especially for clinicians managing certain patients, including those who are aged or infirm, as well as those with underlying conditions such as epidermolysis bullosa (EB), for which a delayed diagnosis is likely lethal. In this review, we have discussed the structure of CSPG4, and quantitatively analysed CSPG4 expression in the tissues and pathologies where it has been identified to determine the usefulness of CSPG4 expression as a diagnostic marker and therapeutic target in management of malignant SCC.

PUBLISHED RESEARCH: Vicki Vuong, 2022 Year 4 MD Project student published research report

Mindfulness-based Interventions and Yoga for Managing Obesity/Overweight After Breast Cancer: A Scoping Review

Vicki Vuong, Vibhuti Rao and Carolyn Ee

Published 20 October 2022

Abstract
Introduction Weight gain after breast cancer is common, and obesity after breast cancer increases breast cancer
recurrence and mortality. Mindfulness-based interventions (MBIs) and yoga have been shown to be effective in managing
obesity/overweight in people without breast cancer. There is a need to systematically map the extent and range of
evidence on yoga and MBIs for managing obesity/overweight after breast cancer in order to aid planning and commissioning
of future research.
Methods We conducted a scoping review informed by methods described by Levac et al. Five electronic databases were
searched for any peer-reviewed original research (including systematic reviews) that examined the role of yoga and/
or MBIs for managing overweight/obesity after breast cancer. Data were extracted on study, population, intervention,
comparator and outcome characteristics, and described narratively.
Results: We found 18 publications representing 15 unique studies (11 clinical trials, 2 systematic reviews, and 2 observational
studies). There were 10 studies on yoga, and 5 on MBIs. Of the clinical trials, only 4/11 examined a weight-related outcome
as the primary outcome. The remaining trials examined lifestyle or metabolic outcomes (5/11) or unrelated outcomes
such as psychological health (2/11). Gaps in the literature included small sample sizes, lack of cultural diversity amongst
participants, inadequate reporting of the intervention, few lifestyle co-interventions offered, lack of active comparator
groups, and inadequate safety reporting.
Conclusions: There is a need for adequately-powered RCTs that adhere to reporting guidelines. The use of gold-standard
methods for measuring outcomes, and active comparator groups, is also recommended.

Congratulations to Year 4, 2022 student, Anneliese McConnell, the overall winner of the School of Medicine's inaugural 3+1Q Student Research Competition

Anneliese presented on her MD Project topic "Exploring Associations Between Hallucinogen Persisting Perception Disorder and Non-Visual Perceptual Disturbances: An Observational Study".

We wish Anneliese well as she represents WSU at the Medical Deans Australia and New Zealand Medical School 3+1Q Competition in November 2022.

Our congratulations also to runner-up Josephine Canceri, another Year 4, 2022 MD Project student, who presented on Rural GP Perspectives on Bowel Cancer Screening.

CONFERENCE SPEAKER: Josephine Canceri, 2022 Year 4 student recounts her experience presenting her MD Project findings at the National Rural Health Conference (NRHC) in Brisbane, along with fellow students Jean-Baptiste Philibert and Baneen Airubayi.

"Serious Toilet Talk" - Exploring Rural GP Perspectives on the National Bowel Cancer Screening Program

The National Rural Health Conference (NRHC) is a biennial conference and the largest public event for those interested in improving health and wellbeing within rural and remote Australia. The conference this year was hosted in Brisbane during 2-4 August 2022. I had the privilege to be invited to present my MD Project research as a ‘Lightning Talk’. This type of presentation requires you present your research thesis, methods, and outcomes in 5 minutes. Whilst a challenging exercise, it is an excellent way to concisely describe your research work to a lay audience. Titled ‘Serious Toilet Talk’, my research explored rural GP perspectives on the National Bowel Cancer Screening Program. Through my research, I was able to learn of the common barriers to patient participation as deemed by rural practitioners, as well as the factors which serve as facilitators. Furthermore, I was provided insight as to potential strategies which GPs believe could help to enhance bowel screening uptake by the eligible population.

The NRHC was an excellent opportunity to meet and network with individuals at the forefront of rural health leadership and innovation. Presentations from nursing, physiotherapy, and other allied health professionals provide great insight into how each of these disciplines are working to improve the health of their rural patients. It was an exciting opportunity to pay witness to the novel advancements working to close the health gap defined by postcode across the Australian landscape.

PUBLISHED RESEARCH:  Keshani Weragama, 2022 Year 4 MD Project student published research report

Diagnostic Stewardship - The Impact of Rapid Diagnostic Testing for Paediatric Respiratory Presentations in the Emergency Setting: A Systematic Review

Keshani Weragama, Dr Poonam Mudgil and Prof John Whitehall

Published 13 August 2022

Congratulations to Keshani Weragama, 2022 Year 4 MD Project  student for achieving another milestone, having a second research paper published. A remarkable achievement being the first student to have research work published in both MD Project years.

Abstract: Antimicrobial resistance is a growing public health crisis, propelled by inappropriate antibiotic prescription, in particular the over-prescription of antibiotics, prolonged duration of antibiotic therapy and the overuse of broad-spectrum antibiotics. The paediatric population, in particular, those presenting to emergency settings with respiratory symptoms, have been associated with a high rate of antibiotic prescription rates. Further research has now shown that many of these antibiotic prescriptions may have been avoided, with more targeted diagnostic methods to identify underlying aetiologies. The purpose of this systematic review was to assess the impact of rapid diagnostic testing, for paediatric respiratory presentations in the emergency setting, on antibiotic prescription rates. To review the relevant history, a comprehensive search of Medline, EMBASE and Cochrane Database of Systematic Reviews was performed. Eighteen studies were included in the review, and these studies assessed a variety of rapid diagnostic testing tools and outcome measures. Overall, rapid diagnostic testing was found to be an effective method of diagnostic antibiotic stewardship with great promise in improving antibiotic prescribing behaviours. Further studies are required to evaluate the use of rapid diagnostic testing with other methods of antibiotics stewardship, including clinical decisions aids and to increase the specificity of interventions following diagnosis
to further reduce rates of antibiotic prescription.

CONFERENCE SPEAKER: Lavina Mital, 2022 Year 4 MD Project student presents at Australasian Stroke Academy Convention in Adelaide

Determining Obstacles in Obtaining Stroke Treatment Faced by First Nations Population in Shoalhaven

Upon Dr Ryan Dashwood and Lavina Mital, 2022 Year 4 WSU MD Project student being awarded one of the Australasian Stroke Academy Research Fellowship Grant, Lavina was invited to present her research goals and findings at the Australasian Stroke Academy Convention on 18 July 2022 in Adelaide.

According to Mital, their goal is to "determine obstacles faced by the First Nations population of Shoalhaven, NSW to ultimately improve their opportunities for time-critical and life-saving stroke treatment to reduce mortality and loss of disability adjusted life years following stroke."

"The public health burden of stroke is set to rise and it is paramount that acute stroke is recognised in regional Australia as a condition that requires emergency action... I am reminded about how research, teamwork and leadership can contribute to the social health and wellbeing of First Nations Australians... engage with your Aboriginal Liaison Officers and find out what you can do as stroke physicians to get more of your patients to you and earlier," says Mital.

PUBLISHED RESEARCH: Keshani Weragama,  2021 Year 3 MD Project student  published  research report

Paediatric Antimicrobial Stewardship for Respiratory Infections in the Emergency Setting: A Systematic Review

Keshani Weragama, Poonam Mudgil and John Whitehall

Published 8 November 2021

Abstract: Antimicrobial resistance occurs due to the propensity of microbial pathogens to develop resistance to antibiotics over time. Antimicrobial stewardship programs (ASPs) have been developed in response to this growing crisis, to limit unnecessary antibiotic prescription through initiatives such as education-based seminars, prescribing guidelines, and rapid respiratory pathogen (RRP) testing. Paediatric patients who present to the emergency setting with respiratory symptoms are a particularly high-risk population susceptible to inappropriate antibiotic prescribing behaviours and are therefore an ideal cohort for focused ASPs. The purpose of this systematic review was to assess the efficacy and safety of ASPs in this clinical context. A systematic search of PubMed, Medline, EMBASE and the Cochrane Database of Systematic Reviews was conducted to review the current evidence. Thirteen studies were included in the review and these studies assessed a range of stewardship interventions and outcome measures. Overall, ASPs reduced the rates of antibiotic prescription, increased the prescription of narrow-spectrum antibiotics, and shortened the duration of antibiotic therapy. Multimodal interventions that were education-based and those that used RRP testing were found to be the most effective. Whilst we found strong evidence that ASPs are effective in reducing antibiotic prescribing, further studies are required to assess whether they translate to equivalent clinical outcomes.

PUBLISHED RESEARCH: Elton Yang,  2021 Year 3 MD Project student  published  research report

Peripheral Cytokine Levels as a Prognostic Indicator in Gastric Cancer: A Review of Existing Literature

Elton Yang 1,2, Wei Chua 1,2,3,4, Weng Ng 1,2,3,4 and Tara Laurine Roberts 1,2,4,*

Published 14 December 2021

Abstract: Although strong connections exist between the carcinogenesis of gastric cancer and chronic inflammation, gastric cancer is unique in that the chronic gastritis which frequently precedes carcinogenesis is strongly associated with H. pylori infection. The interplay between H. pylori virulence factors and host immune cells is complex but culminates in the activation of inflammatory pathways and transcription factors such as NF-κB, STAT3, and AP-1, all of which upregulate cytokine production. Due to the key role of cytokines in modulating the immune response against tumour cells as well as possibly stimulating tumour growth and proliferation, different patterns of cytokine secretion may be associated with varying patient outcomes. In relation to gastric cancer, interleukin-6, 8, 10, 17A, TNF, and IFN-γ may have pro-tumour properties, although interleukin-10, TNF, and IFN-γ may have anti-tumour effects. However, due to the lack of studies investigating patient outcomes, only a link between higher interleukin-6 levels and poorer prognosis has been demonstrated. Further investigations which link peripheral cytokine levels to patient prognosis may elucidate important pathological mechanisms in gastric cancer which adversely impact patient survival and allow treatments targeting these processes to be developed.