Assessment of early and late dysphagia using videofluoroscopy and quality of life questionnaires in patients with head and neck cancer treated with radiation therapy

BACKGORUND: The aim of this study was to evaluate dysphagia in patients with head and neck cancer (HNC) undergoing three-dimensional conformal radiation therapy using objective and subjective tools simultaneously and to associate the clinical correlates of dysphagia with dosimetric parameters. METHODS: Twenty patients were included in the study. The primary tumor and the involved lymph nodes (LN) were treated with 66-70 Gy, the uninvolved LN were treated with 46-50 Gy. Six swallowing structures were identified: the superior pharyngeal constrictor muscle (SPCM), the middle pharyngeal constrictor muscle (MPCM), the inferior pharyngeal constrictor muscle (IPCM), the base of tongue (BOT), the larynx and the proximal esophageal sphincter (PES). Dysphagia was evaluated using videofluoroscopy and European Organization for Research and Treatment of Cancer (EORTC) QoL questionnaire (QLQ-C30) and supplemental EORTC QoL module for HNC (QLQ-H&N35). The evaluations were performed before treatment, at 3 months and at 6 months following treatment. RESULTS: On objective evaluation, the D(max) for the larynx and the sub-structures of the PCM were correlated with impaired lingual movement, BOT weakness and proximal esophageal stricture at 3 months, whereas the V(65), the V(70)and the D(max) for the larynx was correlated with BOT weakness and the V(65), the V(70), the D(max) or the D(mean) for the sub-structures of the PCM were correlated with impaired lingual movement, BOT weakness, reduced laryngeal elevation, reduced epiglottic inversion and aspiration at 6 months following treatment. On subjective evaluation, the V(60), the D(max) and the D(mean) for SPCM were correlated with QoL scores for HNSO at 3 months, whereas the V(70) for SPCM were correlated with QoL scores for HNPA and the V(60), the V(65), the V(70), the D(max) and the D(mean) for SPCM were correlated with QoL scores for HNSO at 6 months following treatment. CONCLUSIONS: The use of multiple dysphagia-related endpoints to complement eachother rather than to overlap with one another, as well as the use of multiple evaluations over time to represent a scale of early to late findings might provide a better insight in terms of the association of the clinical correlates of dysphagia with the dose-volume data for the dysphagia-related anatomical structures

Potential improvement of clinker sand in the mechanical high temperature and transport properties with GGBS-based prepacked geopolymer composite

In this study, a new generation prepacked geopolymer composite (PGC) material that can meet different needs was obtained by combining geopolymer concrete (GPC) and prepacked aggregate concrete (PAC) technology. In the production of PGC, 5-8 mm quartz aggregates were placed in molds and, geopolymer mortar was injected between these aggregates. Aluminosilicate based blast furnace slag (GBFS) was used as binding in geopolymer mortars; sodium silicate (Na2SiO3) and sodium hydroxide (NaOH) was used as alkali activator. In addition, clinker aggregate in different proportions was used as fine aggregate (0–4 mm) in the production of mortar. Within the scope of the study, the physical, mechanical, permeability and high temperature resistance properties of PGC were investigated. The produced samples were cured at 30 and 60 °C for 6 and 8 hours. Hardened unit weights of PGC vary between 2342 and 2539 kg/m3, and sorptivity values vary between 0 and 0.04 kg/m2.min0.5. While the increase in curing temperature and curing time increases the hardened unit weight values, it decreased permeability values. While the increase of clinker aggregate in the mortar phase does not change the hardened unit weight, it significantly reduced permeability. When the PGC samples are cured at 30 °C, the compressive strengths are 20.38–39.03 MPa; when curing at 60 °C, the compressive strengths are 35.21–57.04 MPa. Flexural strengths, 2.35–6.96 MPa with 30 °C cure, achieved 4.27–9.93 MPa results with 60 °C curing. Increasing the curing time and curing temperature significantly increased the compressive and flexural strengths. The increase in the amount of clinker aggregate added to the mortar phase decreased the strength values. While the compressive strength values of PGC mixtures do not fall below 15 MPa after being exposed to 300 °C high temperature; after the application of 600 °C high temperature, it lost up to 70% of its strength. Increasing the curing time and curing temperature, increased the high temperature resistance. The increase in the amount of clinker aggregate in the mixtures, decreased the strength loss rate

Homocysteine, folate and vitamin B12 levels in patients with psoriasis vulgaris treated with low-dose methotrexate

Metotreksat (MTX) şiddetli psoriasis ve psoriatik artrit tedavisinde kullanılan bir folik asit (folat) analoğudur. Düşük doz MTX tedavisinin homosistein (Hey) ve folat düzeylerini etkilediği bildirilmiştir. Çalışmamızda psoriasis vulgaris hastalarında düşük doz MTX tedavisinin erken dönemde serum folat, vitamin B12 ve plazma Hey seviyeleri üzerine etkisini araştırdık. Çalışmaya orta ve şiddetli psoriasis vulgaris tanısı konulan 16 (10 erkek, 6 kadın) hasta ile yaş ve cinsleri uyumlu 20 (12 erkek, 8 kadın) sağlıklı kontrol dahil edildi. Kontrol grubundan ve hastalardan MTX tedavisi öncesi serum folat, vitamin B12 ve plazma Hey için venöz kan alındı. Hastalardan, 4 hafta süresince her hafta, 20 mg intramusküler MTX uygulandıktan 48 saat sonra folat, vitamin B12 ve plazma Hey düzeyleri için tekrar kan örnekleri alındı. Hastaların ve kontrol grubunun tedavi öncesi folat ve plazma Hey düzeyleri arasında anlamlı fark bulunmazken (p>0.05), vitamin B12 değerleri hastalarda kontrol grubundan anlamlı düzeyde düşük idi (p0.05). Metotreksat tedavisi sonrası folat ve Hey seviyeleri arasında ise korelasyon yoktu (p0.05). Düşük doz MTX tedavisinin serum folat seviyesinde kısa süreli azalmaya ve plazma Hey seviyesinde artmaya neden olduğu ve MTX tedavisi süresince Hey seviyesinin artmadığı kanaatine vardık.Background and Design: Methotrexate (MTX), a folic acid (folate) analog, is used for treatment of severe psoriasis or psoriatic arthritis. It has been reported that the&quot; homocysteine (Hey) and folate levels were affected by low dose MTX treatment. In this study we investigated the effect of low dose MTX treatment on folate, vitamin B12 and plasma Hey levels of patients with psoriasis vulgaris at early phase. Material and Method: Sixteen patients (10 males, 6 females) diagnosed as moderate and severe psoriasis vulgaris and age-sex matched twenty healthy subjects (12 males, 8 females) were included in the study. Blood samples were drawn from the both groups before initiation of MTX treatment for folate, vitamin B12 and plasma Hey measurements. Again, after 48 hours following 20 mg intramuscular MTX injection, blood samples of patients were drawn for folate, vitamin B12 and plasma Hey level measurements Results: While there were no significant differences in the folate and plasma Hey levels between patients and healthy subjects (p>0.05), vitamin B12 levels were significantly lower in the patients than the controls (p0.05). There was no correlation been folate and Hey levels after MTX treatment (p>0.05). Negative correlation was found between vitamin B12 and Hey levels before and after treatment (p<0.05). Conclusion: We concluded that low dose MTX treatment cause transient decrease of serum folate levels and transient increase of plasma Hey levels that did not increase throughout the MTX treatment

Impact Of Adjuvant Chemoradiotherapy For Rectal Cancer On The Long-Term Quality Of Life And Late Side Effects: A Multicentric Clinical Evaluation By The Turkish Oncology Group

Aim: Although preoperative chemoradiatherapy (CRT) has proven its benefits in terms of decreased toxicity, there is still a considerable amount of cases that do not receive postoperative CRT. Oncologists at different geographic locations still need to know the long-term effects of this treatment in order to manage patients successfully. The current paper reports on long-term quality of life (QOL) and late side effects after adjuvant CRT in rectal cancer patients from 5 centers in Anatolia. Methods: Rectal cancer patients treated with postoperative CRT with minimum 1-year follow-up and were in complete remission, were evaluated according to RTOG and LENT-SOMA scales. They were also asked to complete Turkish version of EORTC QLQ-C30 questionnaire and the CR-38 module. Each center participated with the required clinical data. Results: Two hundred and thirty patients with median age of 55 years participated and completed the study. Median follow-up time was 5 years. All patients received RT concomitant with chemotherapy. Common parameters that both increased functional health scales and yielded better symptom scores were long term interval after treatment and sphincter-saving surgery. In addition, surgery type and follow-up time were determined to be predictors of QOL scores and late toxicity grade. Conclusion: Postoperative CRT was found to have a great impact on the long term QOL and side effects in rectal cancer survivors. The factors that adversely affect these are abdominoperineal resection and shorter interval. The findings may encourage life-long follow-up and cooperation with patients, which should be mentioned during the initial counseling.WoSScopu

RADIOTHERAPY AS THE PRIMARY AND PALLIATIVE TREATMENT FOR PATIENTS AGED 75 AND OVER WITH LOCALLY ADVANCED AND METASTATIC NON-SMALL CELL LUNG CANCER: ANALYSIS OF 45 CASES WITH A REVIEW OF THE LITERATURE

Aim: To evaluate the prognostic factors and treatment results of Turkish patients aged 75 and over with locally advanced and metastatic non-small cell lung cancer (NSCLC)

Evaluation of the Efficacy of Aprepitant on the Prevention of Chemotherapy-Induced Nausea and Vomiting and Quality of Life with Functional Living Index Emesis

Objective: Functional Living Index Emesis (FLIE) is developed to evaluate the relationship between emesis and it's effects on patient's daily life and is far more relevant to detect the effectiveness of antiemetic treatment compared with self-diary reports. In this study, the efficacy of oral neurokinin-1 antagonist aprepitant on the prevention of chemotherapy-induced nausea and vomiting and quality of life is evaluated with FLIE. Study Design: Cross sectional study. Material and Methods: Sixty patients with Non-Small Cell Lung Cancer (NSCLC) receiving a chemotherapy regimen consisting of Cisplatin and Docetaxel were evaluated. The patients were prospectively randomized to two groups before the first cycle of chemotherapy. Patients in Group A (31 patients) received 3 daily doses of aprepitant along with oral ondansetron and dexamethasone. The patients in group B (29 patients) received only ondansetron and dexamathasone. The efficacy of both regimens was evaluated by a modified Turkish version of FLIE scale consisting of 18 questions. Results: The number of patients with complete response was 31 in the whole group. Of these 18 patients (58%) were in Group A (Aprepitant) and 13 patients in group B (42%). Median FLIE score in group A was 24.97 (±12.45) while it was 38.1 (±26.987) in group B and the difference was statistically significant (p=0.022). Total score >20 was seen in only 5 of 31 patients in aprepitant group (16%) showing the significant efficiency of aprepitant on quality of life, while in group B, 13 of 29 patients (44%) had total scores >20 (p=0.02). Conclusion: Regarding these findings, it is certain to state that aprepitant in combination with other drugs optimizes protection against both nausea and vomiting compared to the prior standard of care, and must be recommended as first-line therapy for patients who are treated with moderately or highly emetogenic chemotherapy

1550-8307/© 2023 Elsevier Inc. All rights reserved.The effect of playing music and mother’s voice to children on sedation level and requirement during pediatric magnetic resonance imaging

Background: Magnetic resonance imaging examinations frequently cause anxiety and fear in children. Theobjective of this study was to investigate the effects of listening to music sound, the mother’s voice, and soundisolation on the depth of sedation and need for sedatives in pediatric patients who would undergo MRI.Methods: Ninety pediatric patients aged 3 to 12 years who were planned for imaging in the MRI unit wererandomly assigned to isolation group (Group I), musical sound group (Group II), and mother’s voice group(Group III). We evaluated patients’ anxiety and sedation levels via the Observer’s Assessment of Alertness/Sedation (OAA/S)Results: Heart rate, oxygen saturation, OAA/S, and Ramsey scores during the procedure were not significantlydifferent among the groups (p&gt;0.05). The mean amount of propofol and total propofol consumption was sta-tistically lower in the mother’s voice group than in the isolation and music sound groups (p&lt;0.001). Meanpropofol amount and total propofol consumption were not significantly different in isolation and music soundgroups (p&gt;0.05). No difference was found between the groups regarding the time it took for the patients’Modified Aldrete score to reach 9 (p&gt;0.05).Conclusions: In pediatric patients, listening to the mother’s voice during MRI decreased the total sedativerequirement consumed without increasing the depth of sedation</p