Retrospective evaluation of trabectedin use in metastatic soft tissue sarcomas: A single-center experience

Çalışmada metastatik yumuşak doku sarkomu tanısıyla trabektedin tedavisi alan hastaların tedavi yanıtları, sağkalım sonuçları, ilaç yan etkilerinin değerlendirilmesi amaçlanmıştır. Sarkom tanısıyla trabektedin tedavisi alan 16 hastanın dosyaları retrospektif olarak tarandı. Hastaların demografik özellikleri, tedavi süreleri, tedavi yanıtları, ilaç yan etkileri kaydedildi. 16 hastanın 9’u erkek (%56,2), 7’si kadındı (%43,7). Trabektedin için medyan progresyonsuz sağkalım (progression-free survival, PFS) 2,9 ay, genel sağkalım (overall survival, OS) 6,7 ay saptandı. Sağkalım üzerine etkili olan tek faktör trabektedin tedavi sırası olarak belirlendi. Trabektedini 2. ya da 3.sıra tedavi olarak alan hastalar daha iyi PFS süresine (medyan PFS 10,3 aya karşı 1,6 ay, %95 GA: 0-21.9, p= 0.003) ve OS süresine (medyan 26,7 ay’a karşı 5,7 ay, %95 GA: 16.9-36.5, p= 0.003) sahipti. Sarkom çalışmalarında objektif yanıt değerlendirme kriteri olarak kullanılan büyüme modülasyon indeksi (growth modulation index, GMI) değeri 1,33’ün üzerinde olan hastaların PFS ve OS süreleri istatiksel anlamlı olarak daha iyiydi (medyan PFS 19,8 ay, p=0.002; medyan OS 26,7 ay, p=0.047). Tüm hastalarda yan etki gözlendi, grad 3/4 yan etkiler hematolojik yan etkiler %62,5 ve alanin aminotransferaz (ALT)/ aspartat aminotransferaz (AST) artışı %50 sıklıkta oldu. Çalışmada saptanan PFS, OS, yanıt oranları ve yan etkiler diğer çalışmalar ile benzer saptanmış, trabektedini 2.ve 3.sıra tedavi olarak alan hastaların ilaçtan daha fazla fayda gördüğü belirlenmiştir.This study aimed to evaluate the treatment responses, survival results, and drug side effects of patients treated with trabectedin for metastatic soft tissue sarcoma. The files of 16 patients who received trabectedin treatment with the diagnosis of sarcoma were reviewed retrospectively. Demographic characteristics of the patients, duration of treatment, response to treatment, and drug side effects were recorded. Of 16 patients, 9 (56.2%) were male and 7 (43.7%) were female. Median progression-free survival (PFS) for trabectedin was 2.9 months, and overall survival (OS) was 6.7 months. The only factor effective on survival was determined as trabectedin treatment line. Patients receiving trabectedin as second or third-line therapy had better PFS time (median PFS 10.3 vs 1.6 months, 95% CI: 0-21.9, p= 0.003) and OS time (median 26.7 vs 5.7 months, 95% CI: 16.9-36.5, p= 0.003). Patients with a growth modulation index (GMI) value above 1.33, which is used as an objective response evaluation metric in sarcoma studies, had statistically significantly better PFS and OS times (median PFS 19.8 months, p=0.002; median OS 26.7 months, p=0.047). Any grade side effects were observed in all patients, grade 3/4 side effects were hematological side effects in 62.5% and alanine aminotransferase (ALT)/ aspartate aminotransferase (AST) increase in 50%. The PFS, OS, response rates and side effects detected in the study were found to be similar to other studies, and it was determined that the patients who received trabectedin as the second and third-line treatment benefited more from the drug

The Ki-67 proliferation index predicts recurrence-free survival in patients with dermatofibrosarcoma protuberans

Dermatofibrosarcoma protuberans (DFSP) is an uncommon soft tissue sarcoma that originates from the dermis or subcutaneous tissue in the skin. While its prognosis is generally favorable, disease recurrence is relatively frequent. Because morbidity after repeated surgery may be significant, an optimized prediction of recurrence-free survival (RFS) has the potential to improve current management strategies. The purpose of this study was to investigate the prognostic value of the Ki-67 proliferation index with respect to RFS in patients with DFSP. We retrospectively analyzed data from 45 patients with DFSP. We calculated the Ki-67 proliferation index as the percentage of immunostained nuclei among the total number of tumor cell nuclei regardless of the intensity of immunostaining. We constructed univariate and multivariate Cox proportional hazards regression models to identify predictors of RFS. Among the 45 patients included in the study, 8 developed local recurrences and 2 had lung metastases (median follow-up: 95.0 months; range: 5.2−412.4 months). The RFS rates at 60, 120, and 240 months of follow-up were 83.8%, 76.2%, and 65.3%, respectively. The median Ki-67 proliferation index was 14%. Notably, we identified the Ki-67 proliferation index as the only independent predictor for RFS in multivariate Cox proportional hazards regression analysis (hazard ratio = 1.106, 95% confidence interval = 1.019−1.200, p = 0.016). In summary, our results highlight the potential usefulness of the Ki-67 proliferation index for facilitating the identification of patients with DFSP at higher risk of developing disease recurrences

Evidence that osteogenic and neurogenic differentiation capability of epidural adipose tissue-derived stem cells was more pronounced than in subcutaneous cells

Background/aim: The management of dura-related complications, such as the repairment of dural tears and reconstruction of large dural defects, remain the most challenging subjects of neurosurgery. Numerous surgical techniques and synthetic or autologous adjuvant materials have emerged as an adjunct to primary dural closure, which may result in further complications or side effects. Therefore, the subcutaneous autologous free adipose tissue graft has been recommended for the protection of the central nervous system and repairment of the meninges. In addition, human adipose tissue is also a source of multipotent stem cells. However, epidural adipose tissue seems more promising than subcutaneous because of the close location and intercellular communication with the spinal cord. Herein, it was aimed to define differentiation capability of both subcutaneous and epidural adipose tissue-derived stem cells (ASCs). Materials and methods: Human subcutaneous and epidural adipose tissue specimens were harvested from the primary incisional site and the lumbar epidural space during lumbar spinal surgery, and ASCs were isolated. Results: The results indicated that both types of ASCs expressed the cell surface markers, which are commonly expressed stem cells; however, epidural ASCs showed lower expression of CD90 than the subcutaneous ASCs. Moreover, it was demonstrated that the osteogenic and neurogenic differentiation capability of epidural adipose tissue-derived ASCs was more pronounced than that of the subcutaneous ASCs. Conclusion: Consequently, the impact of characterization of epidural ASCs will allow for a new understanding for dural as well as central nervous system healing and recovery after an injury.Marmara Universit

Burdur Gölü Uzun Periyotlu Seviye Degisiminin Su Kalitesi ve Agır Metaller Üzerindeki Etkisi

Burdur Gölü, Türkiye'nin en derin göllerinden biri olup, yapı olarak tektonik ve oligotrofik karakterdedir. Suyundaki yüksek sodyum, sülfat ve klorür içerigi nedeniyle bitki türü çesitliligi azdır ve sadece birkaç balık türü yasamaktadır. Göl seviyesi her yıl yagıslı mevsimlerde yükselmekte, yaz aylarında ise buharlasma nedeniyle düsmektedir. Göl, yagmur suları, yeraltından sızmalar ve bir kısmı mevsimsel akan akarsularla ile beslenmektedir. Tarihi kayıtlara göre göl seviyesi jeolojik zamanlarda yükselme ve düsme göstermistir. Gölde hidrojeolojik ve meteorolojik etkilere baglı olarak dönemsel yükselmeler de meydana gelmektedir. Bu yükselme dönemlerinden biri 1971 depremi öncesi tespit edilmistir. Bu tarihten günümüze kadar DSİ 18. Bölge Müdürlügü Burdur Gölü su seviyesinde önemli ölçüde bir azalma belirlemistir. Bu seviye azalması meteorolojik olaylar ve göl çevresinde insa edilen barajların göle giren suyu önemli derecede azaltmasıdır. Bu durum göl suyunun sahip oldugu genel kimyasal yapıda fazla bir etkiye sahip olmamakla beraber göl suyunda bazı agır metallerin son 20 yıllık verilere göre artıs göstermesi seklinde olumsuz bir etki meydana getirmistir. Gölün dısarıya çıkısının olmaması, özellikle nikel, krom ve çinko gibi agır metallerin göl seviyesi düsüsü ile hızlı bir sekilde arttıgı gözlenmistir. Bu çalısma kapsamında incelenen iki yıllık dönem içerisinde gölün kıyı kesimlerinde sahip oldugu fiziksel ve kimyasal su kalitesinin yeraltı suyu beslemesi ve meteorolojik faktörden etkilendigi ve agır metallerin önemli bir degisiklik göstermedigi tespit edilmistir

Community-Acquired Lower Respiratory Tract Infections in the Elderly: Evaluation of 69 Patients

In the future, increase in old population is suspected. Infections, especially lower respiratory tract infections, are serious cause of morbidity and mortality. This study was conducted to be of help in determination of the epidemiology of lower respiratory tract infections that is supposed to be important health problem for our country in the next years. The characteristics of 69 patients over 65 years old, followed in Department of Infectious Disease, Faculty of Medicine, Erciyes University, between 1 January 2000-1 January 2005 were evaluated. Since the study was retrospective, the distinction of typical, atypical and aspiration pneumonia couldn’t be done. Forty-six (67%) of patients were male and 23 (33%) were female and the median of age was 72 (65-90) years. The diagnosis in 50 patients was community-acquired pneumonia, whereas exacerbation of chronic obstructive pulmonary disease in 19 patients. Tachypnea (72%) and tachycardia (65%) were the most frequent physical examination findings. Fifty-five percent of the patients had cognitive dysfunction. High sedimentation rate and C-reactive protein were the common laboratory findings. The microorganisms isolated from the patients’ sputum cultures were; Streptococcus pneumoniae (from five patients), Haemophilus influenzae (from four patients), Pseudomonas aeruginosa (from four patients), Proteus spp. (from three patients), Enterobacter cloacae (from two patients), Klebsiella pneumoniae (from one patient) and normal throat bacterial flora (from 14 patients). Ampicillin-sulbactam and respiratory quinolones were the most frequent used antibiotics. Twelve (17%) patients died. The early diagnosis and therapy of lower respiratory tract infections will reduce the morbidity and mortality of patients. In elderly patients, the classical findings of pneumonia cannot be observed or these findings will be due to underlying disease. More prospective study is needed to determine the epidemiology of lower respiratory tract infections in our country

Endoscopic plantar fasciotomy; Deep fascial versus superficial fascial approach: A prospective randomized study

WOS: 000410023400021PubMed ID: 28842084In the present randomized prospective study, 2 different surgical techniques of endoscopic plantar fascia release were compared. Of 547 patients with a diagnosis of plantar fasciitis, 46 with no response to conservative treatment for >= 6 months were included. Of the 46 patients, 5 were lost to follow-up. In group 1 (n = 21), plantar fascia release was performed using a deep fascial approach (DFA), and in group 2 (n = 20), the superficial fascial approach (SFA) with a slotted cannula technique was used. Patients were evaluated using the American Orthopaedic Foot and Ankle Society Ankle Hindfoot scale and visual analog scale at baseline and 3 weeks and 3, 6, and 12 months after the initial surgery. At the final follow-up appointment, the RolesMaudsley score was used to determine patient satisfaction. At the final follow-up examination, the mean American Orthopaedic Foot and Ankle Society Ankle-Hindfoot scale scores had increased from 53.12 to 83.68, with a decrease in the mean visual analog scale score from 7.95 to 1.65 noted. According to the Roles-Maudsley score, the success rate after 1 year was 90.47% for DFA group, 95% for the SFA group, and 92.68% for all patients. Although no significant difference was found between the final functional scores, better early postoperative scores were found in the SFA group. The mean duration of the procedure was measured as 27.22 +/- 9.41 minutes overall, 35 +/- 5.62 minutes in the DFA group, and 19.05 +/- 4.01 minutes in the SFA group. Two early and two late complications occurred in the DFA group with none reported in the SFA group. In conclusion, the SFA is a faster and safer method of endoscopic plantar fascia release with better early postoperative scores