Can survival in cancer patients be accurately predicted with the Palliative Performance Scale?

Introduction: Palliative Performance Scale (PPS), Karnofsky Performance Scale (KPS) and the Edmonton Symptom Assessment Scale (ESAS) are widely used prognostic scales in palliative care unit. Institutionalized palliative care services in our country are quite new compared to the practices in many countries. We do not have concrete data on the compatibility of these scales, which are developed with patient data from other countries, in our own palliative care practices with real cases. In this study, we aimed to evaluate the convenience of the Turkish versions of these scales on the first days of hospitalization of terminal cancer patients who were followed up in the palliative clinic of our hospital. We also questioned whether the initial estimated survival and actual survival were compatible. Methods: PPS, KPS and ESAS on the first days of hospitalization of terminal cancer patients, hospitalized in the palliative clinic of our hospital between November 14, 2016 and November 14, 2017, were retrospectively evaluated one year later (n = 222). The survivors and those who lost their lives were determined. The survival estimates with PPS of the patients who died were compared with their actual survival.Results: The average age of 222 patients (18% female, 82% male) participating in the study was 64.49 ± 11.62, and the range was 26-91. PPS, KPS, ESAS were determined as a mean value of 34.40±18.00 (min. 10-max. 90), 32.90±17.50 (min. 10-max. 90), 56.10±15.65 (min. 2-max. 90), respectively. The AUC of PPS is 0.83 (p lt;0.001) and the AUC of KPS is 0.78 (p lt;0.001) suggesting that KPS and PPS has at least one tie between alive and dead patients, which is 45%. Median survival time was found 14.00, 95% C.I. [10.87–17.13]. Conclusion: In our study, it was found that as the KPS and PPS scores decrease, the survival time of terminal cancer patients decrease. Patients with PPS lt;45% had a higher risk of death (sensitivity 71%, specificity 80%), patients with KPS lt;45% had a higher risk of death (sensitivity 60%, specificity 81%), and patients with ESAS gt; 60.50 had a higher risk of death (sensitivity 93%, specificity 45%). PPS is a useful assessment scale for predicting survival of terminal cancer patients in the palliative care unit. We think it is important in determining our patient-specific palliative approach and treatments

Experimental laboratory modeling of choroidal vasculature: A study of the dynamics of intraoperative choroidal hemorrhage during pars plana vitrectomy

Amaç: Koroid kanamaları (KK), koroid damarlarının rüptürü ve kanın supra koroid boşluğuna ekstravazasyonu ile meydana gelir. Koroid damar sistemini daha iyi şekilde anlamak için, bu çalışmada amaca yönelik olarak ölçeklendirilmiş bir model kullanıldı. Bu model aracılığıyla, koroid damar sistemindeki stres düzeyleri farklı koşullar altında ölçüldü. Gereç ve Yöntem: Koroid damar yapısı modelinde, 1 cm genişliğinde ve 10 cm uzunluğunda lastik bir tüp kullanıldı. Modeldeki stres seviye ölçümü için ise özel iletken iplik kullanıldı. Modeldeki stres seviyeleri, farklı sistemik intravasküler kan basıncı seviyeleri (İVB), farklı göz içi basınç seviyeleri (GİB) ve farklı distorsiyon seviyeleri altında ölçüldü. Bulgular: Koroid damar modelindeki stres değerleri GİB ile negatif, İVB ve distorsiyon ile pozitif korelasyon gösterdi. Tüm korelasyonlar istatistiksel olarak anlamlı idi (p<0,05). Ancak, modelde ekspansil tamponad kullanıldığında bu korelasyon ekspansil olmayan tamponadlara göre daha kuvvetliydi. Distorsiyonun stres ile korelasyonu, İVB’nin korelasonuna göre daha güçlü idi. İVB’nin stres ile korelasyonu ise, GİB’nin korelasonuna göre daha güçlü idi. Distorsiyondan kaynaklanan damar yapısındaki stres, yüksek GİB etkisi ile karşılaştırıldığında gerileme gösterirken, yüksek İVB’den kaynaklanan damar yapısındaki stres tam tersine hafif bir artış sergiledi. Sonuç: Cerrahi işlemler sırasında göz küresinin aşırı distorsiyonu, nadiren görülen intraoperatif KK’lerin başlıca nedeni olabilir. Ekspansil olmayan oküler tamponat kullanımı, koroid kanamasına karşı vasküler yatak için daha iyi destek sağlar ve koroid kanaması saptanan hastalarda önerilen tampon çeşidi olmalıdır. GİB’nin aşırı artırılması, distorsiyondan kaynaklanan koroid damarlarındaki kanama riskinin önlenmesinde sınırlı etkiye sahiptir.Objectives: Choroidal hemorrhages (CH) result from rupture of choroidal vessels leading to extravasation of blood into the suprachoroidal space. In this study, we aimed to understand the hemodynamics of CH by developing a purpose-built scale model of the choroidal vasculature and calculating stress levels in the model under different conditions. Materials and Methods: We modeled the choroidal vasculature using a rubber tube 10 cm in length and 1 cm in diameter that was wrapped with conductive thread to enable the measurement of stress at the walls of the tube. Stress levels across the tube were continuously measured under different systemic intravascular blood pressure levels (IVP), intraocular pressure (IOP) levels, and distortion. Results: Stress values across the choroidal vessel model correlated negatively with IOP and positively with IVP and distortion. All correlations were statistically significant (p<0.05) and were stronger when the model was filled with expansile tamponade compared to non-expansile tamponades. Distortion showed the strongest correlation in terms of increasing stress across the model, while IVP showed stronger correlation compared to IOP. Raising IOP to counteract the stress in the model was effective when the stress in the model was secondary to increased IVP, but this approach was not effective when the stress in the model was caused by distortion. Conclusion: Excessive distortion of the globe during surgical maneuvers could be the primary reason for the rarely observed intraoperative CH. Non-expansile ocular tamponade provides better support for the vascular bed against CH and should be the recommended choice of tamponade in patients with existing CH. Increasing IOP excessively is of limited effect in preventing CH in vessels that are under stress as a result of distorting surgical maneuvers

Experimental laboratory modeling of choroidal vasculature: A study of the dynamics of intraoperative choroidal hemorrhage during pars plana vitrectomy

Objectives: Choroidal hemorrhages (CH) result from rupture of choroidal vessels leading to extravasation of blood into the suprachoroidal space. In this study, we aimed to understand the hemodynamics of CH by developing a purpose-built scale model of the choroidal vasculature and calculating stress levels in the model under different conditions. Materials and Methods: We modeled the choroidal vasculature using a rubber tube 10 cm in length and 1 cm in diameter that was wrapped with conductive thread to enable the measurement of stress at the walls of the tube. Stress levels across the tube were continuously measured under different systemic intravascular blood pressure levels (IVP), intraocular pressure (IOP) levels, and distortion. Results: Stress values across the choroidal vessel model correlated negatively with IOP and positively with IVP and distortion. All correlations were statistically significant (p<0.05) and were stronger when the model was filled with expansile tamponade compared to non-expansile tamponades. Distortion showed the strongest correlation in terms of increasing stress across the model, while IVP showed stronger correlation compared to IOP. Raising IOP to counteract the stress in the model was effective when the stress in the model was secondary to increased IVP, but this approach was not effective when the stress in the model was caused by distortion. Conclusion: Excessive distortion of the globe during surgical maneuvers could be the primary reason for the rarely observed intraoperative CH. Non-expansile ocular tamponade provides better support for the vascular bed against CH and should be the recommended choice of tamponade in patients with existing CH. Increasing IOP excessively is of limited effect in preventing CH in vessels that are under stress as a result of distorting surgical maneuvers

Can survival in cancer patients be accurately predicted with the Palliative Performance Scale?

Introduction: Palliative Performance Scale (PPS), Karnofsky Performance Scale (KPS) and the Edmonton Symptom Assessment Scale (ESAS) are widely used prognostic scales in palliative care unit. Institutionalized palliative care services in our country are quite new compared to the practices in many countries. We do not have concrete data on the compatibility of these scales, which are developed with patient data from other countries, in our own palliative care practices with real cases. In this study, we aimed to evaluate the convenience of the Turkish versions of these scales on the first days of hospitalization of terminal cancer patients who were followed up in the palliative clinic of our hospital. We also questioned whether the initial estimated survival and actual survival were compatible. Methods: PPS, KPS and ESAS on the first days of hospitalization of terminal cancer patients, hospitalized in the palliative clinic of our hospital between November 14, 2016 and November 14, 2017, were retrospectively evaluated one year later (n = 222). The survivors and those who lost their lives were determined. The survival estimates with PPS of the patients who died were compared with their actual survival.Results: The average age of 222 patients (18% female, 82% male) participating in the study was 64.49 ± 11.62, and the range was 26-91. PPS, KPS, ESAS were determined as a mean value of 34.40±18.00 (min. 10-max. 90), 32.90±17.50 (min. 10-max. 90), 56.10±15.65 (min. 2-max. 90), respectively. The AUC of PPS is 0.83 (p lt;0.001) and the AUC of KPS is 0.78 (p lt;0.001) suggesting that KPS and PPS has at least one tie between alive and dead patients, which is 45%. Median survival time was found 14.00, 95% C.I. [10.87–17.13]. Conclusion: In our study, it was found that as the KPS and PPS scores decrease, the survival time of terminal cancer patients decrease. Patients with PPS lt;45% had a higher risk of death (sensitivity 71%, specificity 80%), patients with KPS lt;45% had a higher risk of death (sensitivity 60%, specificity 81%), and patients with ESAS gt; 60.50 had a higher risk of death (sensitivity 93%, specificity 45%). PPS is a useful assessment scale for predicting survival of terminal cancer patients in the palliative care unit. We think it is important in determining our patient-specific palliative approach and treatments

Enfeksiyöz laringotraheitis ile doğal enfekte yumurta tavuklarında solunum kanalı lezyonları üzerine immunohistokimyasal çalışmalar

Zeki Aras (Aksaray, Yazar)In this study, naturally infected by Gallid Herpesvirus type-1 in laying hens to be diagnosed by pathological and PCR methods. Sixty pieces of hens were collected in coops from Central Anatolia region. After necropsy, routine pathological processes were applied to the trachea/ larynx, sinuses, lungs and air sacs. All organs were also stained by immunoperoxidase method, and PCR methods were applied to formalin fixed paraffin embedded (FFPE) tissues. Immunohistochemically, the positivities were seen in trachea/larynx (78.3%), sinuses (61.6%), lungs (45%) and air sacs (50%). Positive reactions were observed, in mucous and gland epithelia especially located at intracytoplasmic and rarely intranuclear. PCR positivity was observed in the trachea/larynx in 15 (25%) cases, in infraorbital sinus in 11 (18.3%) cases, in lungs in 8 (13.3%) cases and in air sacs in 6 (10%) cases following the tests performed. Following these results, it is easily concluded that histopathology and immunoperoxidase method can usable for diagnosing of the ILT. However, PCR results made by FFPE tissues showed that this method is not adequate to diagnose the ILT alone.Bu çalışmada Gallid Herpesvirus tip-1 ile doğal enfekte yumurta tavuklarında patolojik yöntemlerle teşhis konularak immunohistokimyasal ve PCR yöntemlerinin teşhiste kullanılabilirliği araştırıldı. Bu amaçla Orta Anadolu’da bulunan bazı illerdeki kümeslerden toplam 60 adet enfekte tavuk toplandı. Yapılan nekropsilerin sonrasında trake, larinks, infraorbital sinus, akciğer ve hava kesesi parçaları alınarak rutin patolojik işlemler uygulandı. Alınan tüm organlar ayrıca indirekt immunperoksidaz yöntemi ile boyandı ve organlara ait formolle fikse edilmiş parafine gömülü (FFPG) dokulara PZR testi yapıldı. İmmunohistokimyasal boyamalar sonucu trake/larinkste %78.3, sinuslarda %61.6, akciğerlerde %45 ve hava keselerinde %50 oranında pozitiflik gözlendi. Pozitif boyanmalar özellikle mukoza ve bez epitellerinde intrasitoplazmik nadiren de intranüklear olarak gözlendi. Aynı zamanda lümene dökülmüş eksudattaki hücre ve sinsityal dev hücrelerinin sitoplazmalarında da boyanmalar tipikti. Yapılan PCR testlerinin ardından trake/larinkste %25, infraorbital sinuslarda %18.3, akciğerlerde %13.3, hava keselerinde %10 oranında pozitiflik gözlendi. Bu sonuçların ardından hastalığın teşhisinde histopatolojik ve immunperoksidaz yönteminin rahatlıkla kullanılabileceği ortaya konmuştur. Ancak, FFPG dokulardan yapılan PCR yönteminin tek başına İLT’yi teşhis etmek için yeterli olmadığı gösterildi

Immunohistochemical Studies on Infectious Laryngotracheitis in the Respiratory Tract Lesions in Naturally Infected Laying Hens

In this study, naturally infected by Gallid Herpesvirus type-1 in laying hens to be diagnosed by pathological and PCR methods. Sixty pieces of hens were collected in coops from Central Anatolia region. After necropsy, routine pathological processes were applied to the trachea/larynx, sinuses, lungs and air sacs. All organs were also stained by immunoperoxidase method, and PCR methods were applied to formalin fixed paraffin embedded (FFPE) tissues. Immunohistochemically, the positivities were seen in trachea/larynx (78.3%), sinuses (61.6%), lungs (45%) and air sacs (50%). Positive reactions were observed, in mucous and gland epithelia especially located at intracytoplasmic and rarely intranuclear. PCR positivity was observed in the trachea/larynx in 15 (25%) cases, in infraorbital sinus in 11 (18.3%) cases, in lungs in 8 (13.3%) cases and in air sacs in 6 (10%) cases following the tests performed. Following these results, it is easily concluded that histopathology and immunoperoxidase method can usable for diagnosing of the ILT. However, PCR results made by FFPE tissues showed that this method is not adequate to diagnose the ILT alone

The significance of neutrophil-to-lymphocyte ratio in idiopathic epiretinal membrane

WOS: 000439166500005PubMed ID: 28608032To assess the levels of neutrophil-to-lymphocyte ratio (NLR) in patients with idiopathic epiretinal membrane (iERM) and to compare the NLR results of patients with iERM and healthy controls. This retrospective study enrolled 43 patients with iERM and 40 healthy subjects. Complete ophthalmologic examination and complete blood count measurements were performed of all subjects. Complete blood counts were performed within 2 h of blood collection. There was a significant difference in NLR between iERM and control groups (p <0.01). The receiver operating characteristics analysis revealed that the value of NLR to distinguish patients with iERM and controls was found to be 0.832. The best cutoff value was 1.90, with a sensitivity of 72% and specificity 70%. Our study for the first time provides evidence that subclinical systemic inflammation may cause or at least accompanies iERM using a novel biomarker NLR

Obrazovni program kulturne baštine za učenike srednje škole

This study assumes that education with age- and level-appropriate methods and materials at an early age plays a strategic role in passing cultural heritage on to future generations. The study aimed to analyze the data derived from the project titled “TUBITAK 4004: Nature Education and Science Schools Support Program: We Protect Our Cultural Heritage in Trabzon”. Thirty secondary school students (fifth-eighth graders) from Trabzon participated in the project with the following objectives: explaining the concept of cultural heritage, raising students’ awareness of Trabzon’s cultural heritage and teaching them how to promote and preserve Trabzon’s cultural heritage. The project consisted of four stages. First, a review of literature review on cultural heritage was conducted. Second, pretests were administered to participants to assess their knowledge and awareness of cultural heritage. Third, participants attended seminars, drama events, workshops and trips to experience Trabzon’s cultural heritage. Fourth, participants solved the posttests in order to assess their knowledge and awareness of cultural heritage. The main goal was to determine whether the project affected their knowledge and awareness of cultural heritage, and the results showed that the CHEP improved participants’ knowledge level. Before the programme’s implementation they did not know much about Trabzon’s cultural heritage, but after the CHEP’s implementation, they had more knowledge and awareness of the topic. The results show that children should be provided with cultural heritage education via different methods.U ovom istraživanju kreće se od pretpostavke da obrazovne metode primjerene dobi i razini obrazovanja primijenjene u ranoj dobi igraju stratešku ulogu u prenošenju kulturne baštine budućim generacijama. Cilj istraživanja bio je analizirati podatke dobivene provedbom projekta „TUBITAK 4004: Program obrazovanja za okoliš podrške prirodoslovnim školama: štitimo kulturnu baštinu Trabzona“. Trideset učenika niže srednje škole (peti, šesti, sedmi i osmi razred) iz Trabzona sudjelovalo je u provedbi projekta, sa sljedećim ciljevima: objasniti koncept kulturne baštine, podići razinu osviještenosti učenika o kulturnoj baštini Trabzona, poučiti učenike kako promicati i očuvati kulturnu baštinu Trabzona. Projekt se sastojao od četiri faze. Prvo je proveden pregled literature o kulturnoj baštini, nakon čega su, u drugoj fazi, provedeni predtestovi kako bi se procijenilo predznanje sudionika i njihova osviještenost o kulturnoj baštini. U sklopu treće faze projekta učenici su sudjelovali na seminarima, dramskim događajima, radionicama i putovali s ciljem doživljavanja kulturne baštine Trabzona. U četvrtoj fazi provedeni su posttestovi kako bi se procijenili znanje sudionika i njihova razina osviještenosti o kulturnoj baštini nakon provedbe projekta. Glavni cilj istraživanja bio je utvrditi utjecaj provedbe projekta na znanje i osviještenost učenika o kulturnoj baštini. Rezultati su pokazali da je OPKB unaprijedio razinu znanja sudionika. Prije OPKB-a nisu znali mnogo o kulturnoj baštini Trabzona, ali nakon provedbe projekta imali su više znanja i njihova svijest o temi istraživanja bila je na višoj razini. Rezultati također pokazuju da obrazovanje djece u području kulturne baštine treba provoditi putem raznolikih metoda.