Investigation of the Parameters That May Predict Hemodialysis Frequency

DergiPark: 819242tmsjAims: This study investigates the relationship between the clinical parameters at the beginning of hemodialysis therapy and the changing in the frequency of weekly hemodialysis sessions in ongoing treatment. Methods: The study population was composed of all of the patients that were started chronic hemodialysis treatment between January 2015 and January 2020. The patients were classified as twice-weekly (2/7) and thrice-weekly (3/7) groups according to the hemodialysis schedule at the start of treat- ment. The 3/7 group is additionally subdivided according to the dialysis schedule switches to the thrice-weekly program. Basal demographics and biochemical parameters were obtained from medical records at the start of hemodialysis. Results: The total number of subjects in the study was 433 (141 in the twice-weekly program, 292 in the thrice-weekly program). Forty-six (32.6%) patients in twice-weekly hemodialysis program were shifted to a thrice-weekly program during the follow-up. The female/ male ratio in the 2/7 program is different from the 3/7 program. Serum creatinine and C-reactive protein levels were higher in patients on the 3/7 program. Serum calcium and albumin levels were higher in patients on a 2/7 program. The statistically sig- nificant increments were found in calcium, hemoglobin, hematocrit, urea, creatinine, and potassium levels between the before and after switch results of the 3/7 group which switched from 2/7. Conclusion: Urea, creatinine, and potassium levels can guide the decision to compose a hemodialysis schedule. However, patients' future weekly treatment schedules cannot be predicted by biochemical parameters obtained at the start of hemodialysis

Ulusaldan Küresele: Popülizm, Demokrasi, Güvenlik Konferansı

Öngörülmesi giderek güçleşen, sarsıntılı ve savrulmalı zamanlardan geçiyoruz. İkinci Dünya Savaşı ve Soğuk Savaş ortak deneyimleri sonrasında 1950’lerden ve 1990’lardan itibaren demokratik sistemlerin peş peşe dalgalarla meşrulaşacağı, yaygınlaşacağı ve güçleneceği öngörüsü hakimdi. Ancak son yıllarda yaşanan bazı gelişmelerle demokrasilerin geleceği tekrar sorgulanmaya başladı. Gerek 11 Eylül ile başlayan ve IŞİD ile devam eden ve şiddet içeren İslamcı radikalizm, gerek Batı demokrasilerinde popülist radikal sağ hareketlerin ve beyaz ırkçı grupların yükselişi ve iktidara gelişi, bir yandan güvenlik-özgürlük ikileminin demokrasi dengesini bozdu, bir yandan da hem demokratik sistemlerin hem dünya barışının geleceğini bizi tekrar sorgular, sorgulatır hale getirdi. Demokrasileri bildiğimizi zannediyoruz, ama demokrasiler ile ilgili daha öğrenmemiz gereken çok şey var. Demokrasi kaderimiz de geleceğimiz de olmak zorunda değil belki de. Ya da belki yanlış yerden soru sormaya başlıyoruz, belki demokrasi yerine yeni bir referansa ihtiyacımız var. Aslında demokrasileri çantada keklik görmeyip, sabırla büyütüp yeşertmek, geliştirmek, korumak, ileri safhalara taşımak ve bizden sonraki nesillere aktarmak bir sorumluluk, ve bu sorumluluk bizlere ait. Popülizm, demokrasi, güvenlik kavramlarının her biri bugün sıkça ve yaygın olarak kullandığımız kavramlar olarak gündelik sohbetlerimizin içine kadar girmiş durumda. Bu yaygın kullanımlarına rağmen her bir kavram, üzerine düşünmeye, tartışmaya ve değerlendirmeye tekrar tekrar olanak verecek derinlikte. Her bir tartışma bir diğerini açarken, farklı gibi görünen bu kavramların birbirleriyle kesiştikleri zeminler bulmak mümkün. Popülist liderlerin politikaları bütün siyaset yapma biçimlerini kendine çeken ya da kendinden uzaklaştıran eksenler yaratarak her ikisini de aynı anda besleyebiliyor. Popülist politikaya angaje olan liderler ve grupların yanında bu politikaya karşı mücadele eden kişiler ve kitleler de yok değil, ancak kimi zaman bu kitleler eleştirdiği bu siyaset biçiminin kurucu öznesi haline de gelebiliyor. Bunun karşısında tabandan gelen demokratikleşme talepleri ve popülist siyasetle beraber kurumsallaşan diğer politika yapma biçimleri, demokrasi anlayışımızı farklı yönlere çekebiliyor. Bu demokratikleşme talepleri kimi zaman olumlu karşılıklar alsa da, kimi zaman devletlerin güvenlik politikaları ile etkisizleştirilmeye ve bastırılmaya çalışılıyor. Güvenlik politikalarının alanı günümüz teknolojisi sebebiyle o kadar genişledi ki, bu politikanın nesnesi haline gelmemiş varlık ve alan bulmak neredeyse mümkün değil. Ulusaldan Küresele: Popülizm, Demokrasi, Güvenlik konferansımız bu alanların kendine özgülüklerini göz önünde bulundururken, aralarındaki kesişimleri de ortaya koyan pek çok değerli sunuma ev sahipliği yaptı. Konferansın düzenlenmesinde emeği geçen herkese, ve bu bildiri kitabında tam metinleri ve özetleri bulunan bütün katılımcılarımıza çok teşekkür ederiz.Publisher's Versio

Kemik metastazlı hastalarda palyatif radyoterapi sonrası idrar kalsiyum ve deoksipiridinolin seviyeleri

Bu çalışmada metastatik kemik hastalığı olan hastalarda palyatif radyoterapi sonrası idrar kalsiyum ve Deoksipiridinolin (DPD) seviyelerindeki değişim araştırılmış ve ön değerlendirme sonuçları verilmiştir. Primer akciğer veya meme kanserli, radyografik olarak kemik metastazı saptanmış, ağrısı olan ancak analjezik tedavisine cevap vermeyen 19 hasta bu çalışmaya alınmıştır. Hastaların 7'si kadın, 12'si erkek olup medyan yaş 58'dir (43-84 yaş). İdrar kalsiyum ve DPD seviyeleri radyoterapi öncesi, radyoterapi sonrası 6. ve 12. haftalarda ölçülmüştür. Hastaların tümüne 3 Gy günlük fraksiyon dozunda toplam 30 Gy eksternal radyoterapi uygulanmıştır. Radyoterapi öncesi hastaların idrar kalsiyum seviyeleri ortalama 17.53 ± 3.60 g/dl/µmol kreatinin ve ortalama idrar DPD seviyesi 100.12 ± 70.39 pmol/µmol kreatinin olarak bulunmuştur. Ondört hasta metastatik kemik hastalığında progresyon olmaksızın izlemdedir (Grup I). Bu grup hastalarda radyoterapi sonrası idrar kalsiyum ve DPD seviyelerinde istatiksel olarak anlamlı bir düşüş saptanmıştır (idrar kalsiyumu için p<0.001 ve idrar DPD için p<0.001). Klinik ve radyolojik değerlendirmeler sonucunda 5 hastada metastatik kemik hastalığında progresyon olduğu görülmüştür (Grup II). Bu hastalarda ise idrar kalsiyum ve DPD seviyelerinde istatiksel olarak önemli bir artış olduğu bulunmuştur (idrar kalsiyumu için p=0.006 ve idrar DPD için p=0.009). Metastatik kemik hastalığında palyatif radyoterapiye cevabın değerlendirilmesi için idrar kalsiyum ve DPD seviyelerinin takibi objektif bir kriter olarak kullanılabilir ve hastalık progresyonun erken saptanmasını sağlayabilir.We prospectively evaluated the predictability of urine calcium and deoxypyridinoline (DPD), the two bone resorption markers, in the assessment of objective response to palliative radiation therapy (RT) for metastatic bone disease. Nineteen patients with radiographic evidence of metastatic bone disease due to breast or lung primaries, and suffering from persisting pain despite analgesic treatment were enrolled in this prospective study. There were 7 female and 12 male with a median age of 58 years (range 43 to 84 years). Urine samples for the measurement of urinary calcium and DPD levels were taken at the beginning of RT, sixth week, and twelfth week following RT. All patients received a total dose of 30 Gy in 3 Gy daily fraction doses 5 days a week for 10 days. Mean urine calcium and DPD levels before RT for whole patients were 17.53 &plusmn; 3.60 g/dl/&micro;mol creatinine, and 100.12 &plusmn; 70.39 pmol/&micro;mol creatinine. Fourteen patients (Group I) were alive with no evidence of progression of metastatic bone disease. Urine calcium and DPD levels were found to show a significant and progressive decrease after RT in Group I patients (p&lt;0.001 for urine calcium and p= p&lt;0.001 for urine DPD). Clinical and radiological evaluation revealed further bone dissemination of malignancy in five patients (Group II). Urine DPD and calcium concentrations were found to increase significantly in Group II patients (p=0.006 for urine calcium and p=0.009 for urine DPD). Our preliminary results demonstrated that both urine calcium and DPD may serve as valuable objective tools for assessing response to palliative RT of metastatic bone disease, and may serve as early predictors of disease progression

Validation of the Eortc Qlq-Oes18 Questionnaire in Patients Treated with Radiotherapy

Esophagitis is a very common toxicity of radiotherapy (RT). European Organization for the Research and Treatment of Cancer (EORTC) quality of life questionnaire (QLQ)-OES18 can be used to measure the quality of life (QoL) associated with esophageal symptoms. We aimed to translate and validate this questionnaire in Turkish patients. Patients with head and neck cancer (HNC), lung cancer (LC) or esophageal cancer (EC) were administered the EORTC QLQ-C30 and QLQ-OES18 on the 1st, 15th, and last days of RT and at the 3rd month follow-up. Psychometric properties of reliability, validity, scale structure and responsiveness to change were analyzed. Ninety-seven patients were included in the study. All scores in the QLQ-C30, and all but the reflux scores in the QLQ-OES18 were found to change significantly during and after treatment. All correlations of the QLQ-OES18 scale between the 1st and 15th days, 15th and last days, and all but the trouble with coughing score between the last day and follow-up were significantly different. Correlation levels ranged between 33.5-79.9%, 48.7-87.2%, and 0.6-74.8% at each comparison period, respectively. The reliability was evaluated by Cronbach's alpha at each assessment period, and the result was 0.824, 0.889, 0.898, and 0.824 for treatment start, mid-treatment, treatment end, and 3rd month follow-up, respectively. The Turkish version of QLQ-OES18 is a valid tool which can be used independently from the demographic and clinical characteristics of the patients. It is highly reliable to evaluate health-related QoL in patients with esophageal symptoms that are treated for HNC, LC, or EC.WoSScopu

Radiosensitization induced by zinc-doped hydroxyapatite nanoparticles in breast cancer cells

Zinc-doped hydroxyapatite (HA) nanoparticles were synthesized by microwave assisted method and used with ionizing radiation for inhibition of proliferation of breast cancer cells. Zinc-doped HAs were produced in four different compositions in order to determine the best doping rate in terms of physical and biological properties. Nanoparticle characterizations were performed with X-ray diffractometer, Fourier transform infrared spectroscopy, scanning electron microscopy, and inductively coupled plasma-mass spectrometry. Viability of MDA-MB-231(isolated at M D Anderson from a pleural effusion of a patient with invasive ductal carcinoma) cells treated with nano-HA particles and radiation were assessed by MTT assay. Caspase-7 and Poly (ADP-ribose) polymerase protein expressions in samples were examined by the Western blot. X-ray diffraction patterns of our samples were found to be in good correlation with the reference HA peaks. Notably, increasing zinc amount resulted in elevated percentage of beta-tricalcium phosphate, phases. All formulations including pure HA particles were non-cytotoxic in MDA MB 231 cells. On the other hand, low rate Zn-doped HA particles showed significant anti-proliferation effect during irradiation. The combination of irradiation with Zn-doped HA particles also induced apoptosis, demonstrated as cleavage of caspase-7 and PARP proteins. In conclusion, low rate Zn-doped HA enhanced the radiation effect on breast cancer cells

Treatment outcomes of metastasis-directed treatment using(68)Ga-PSMA-PET/CT for oligometastatic or oligorecurrent prostate cancer: Turkish Society for Radiation Oncology group study (TROD 09-002)

Purpose The aim of this study was to evaluate the outcomes of(68)Ga prostate-specific membrane antigen (Ga-68-PSMA) positron-emission tomography (PET)/CT-based metastasis-directed treatment (MDT) for oligometastatic prostate cancer (PC). Methods In this multi-institutional study, clinical data of 176 PC patients with 353 lesions receiving MDT between 2014 and 2019 were retrospectively evaluated. All patients had biopsy proven PC with = 3 acute toxicity, but one patient had a late grade 3 toxicity of compression fracture after spinal SBRT. Conclusion Ga-68-PSMA-PET/CT-based MDT is an efficient and safe treatment for oligometastatic PC patients. Proper patient selection might improve treatment outcomes

Review of Current Status of Radiotherapy Facilities and Assessment of Required Time for Radiotherapy Delivery Workflow in Turkey: On Behalf of Turkish Society for Radiation Oncology

The aim this study is to evaluate current status and workload of radiotherapy (RT) centers in Turkey, by assessing time and staff required during core treatment procedures in patients with different tumor sites. A survey sent via e-mail to all hospitals that are actively treating patients with RT, that aimed expose the details on type of the techniques being used and the time spent for treatment planning and delivery for the different techniques according to different tumor sites. The results were evaluated by several variables, the type of the center (university hospitals or state-run hospitals) and the number of patients treated per year per center (<1000 patients/year treated vs. 000 patients/year treated). The survey was sent to 48 centers and the return rate was 71% (34 centers). Average daily treatment course performed by one physician was 192 per year (range: 41 - 650). Median number of patients treated by a specialist per year was 210 (range: 79 - 650) in the university hospitals and 101 (range: 41 - 167) in the state-run hospitals. Median time spent for treating a patient with 3-dimensional conformal RT (3DCRT) was 4 h, and it was 5 h 45 min for intensity-modulated AT (IMRT). The time spent for all cancer types treated with 3DCRT and IMRT was higher in state-run hospitals compared to university hospitals. With increasing use of newer AT techniques, the time spent for treating patients increases. Besides adequate equipment, sufficient and well-trained staff is required to achieve these newer AT technique benefits for the patients

Türkiye'deki Radyoterapi Donanımının Mevcut Durumu ve Radyoterapi Uygulaması için Gereken Sürenin İncelenmesi: Türk Radyasyon Onkolojisi Derneği Çalışması

Türkiye'deki Radyoterapi Donanımının Mevcut Durumu ve Radyoterapi Uygulaması için Gereken Sürenin İncelenmesi: Türk Radyasyon Onkolojisi Derneği ÇalışmasıBu çalışmanın amacı, Türkiye'deki radyoterapi (RT) merkezlerinin güncel durumu ve iş yükü değerlendirmesi, farklı tümörlü hastaların tedavi sırasında ekibin harcadığı süreler analiz ederek değerlendirmektir. Farklı tümörlerin tedavisi sırasında kullanılan teknikleri ve farklı teknikler için tedavi planlaması ve uygulam sırasında harcanan zamanı değerlendirmek amacı ile, aktif olarak RT uygulaması yapan tüm hastanelere e-mail yolu ile anket yollanmıştır. Sonuçlar, merkez türü (üniversite hastanesi veya devlet hastanesi) ve yıllık tedavi edilen hasta sayısına (yıllık tedavi edilen hasta sayısı 1000 veya yıllık tedavi edilen hasta sayısı 1000) göre değerlendirilmiştir. Anket 48 merkeze gönderilmiş olup ankete yanıt oranı %71 (34 merkez) olarak bulunmuştur. Bir hekimin yıllık tedavi seansı 192 olarak bulunmuştur. Hekimin yıllık tedavi edilen ortalama hasta sayısı üniversite hastanesinde 210 ve devlet hastanesinde ise 101 olarak bulunmuştur. Bir hastayı 3-boyutlu konformal RT (3BKRT) ile tedavi etmek için harcanan ortalama süre 4 saat iken, yoğunluk ayarlıklı RT (YART) için harcanan süre ise 5 saat 45 dakika olarak bulunmuştur. Devlet hastanalerinde tüm hasta grubunda 3BKRT ve YART için harcanan süre üniversite hastanelerine göre daha yüksek bulunmuştur. Yeni RT tekniklerinin artan kullanımına paralel olarak, hastaların tedavisi için harcanan süre de de artmaktadır. Yeni RT tekniklerinin hastaların yararı için uygulamak için, yeterli ekipman ile birlikte, uygun ve eğitimli ekip gerekmektedir.The aim this study is to evaluate current status and workload of radiotherapy (RT) centers in Turkey, by assessing time and staff required during core treatment procedures in patients with different tumor sites. A survey sent via e-mail to all hospitals that are actively treating patients with RT, that aimed expose the details on type of the techniques being used and the time spent for treatment planning and delivery for the different techniques according to different tumor sites. The results were evaluated by several variables, the type of the center (university hospitals or state-run hospitals) and the number of patients treated per year per center (>1000 patients/year treated vs. <1000 patients/year treated). The survey was sent to 48 centers and the return rate was 71% (34 centers). Average daily treatment course performed by one physician was 192 per year . Median number of patients treated by a specialist per year was 210 in the university hospitals and 101 in the state-run hospitals. Median time spent for treating a patient with 3-dimensional conformal RT (3DCRT) was 4 h, and it was 5 h 45 min for intensity-modulated RT (IMRT). The time spent for all cancer types treated with 3DCRT and IMRT was higher in state-run hospitals compared to university hospitals. With increasing use of newer RT techniques, the time spent for treating patients increases. Besides adequate equipment, sufficient and well-trained staff is required to achieve these newer RT technique benefits for the patients