Importância prognóstica de depósitos de tecido mole no carcinoma laríngeo

Introduction: Soft tissue deposits is tumorous islands apart from lymph nodes and occasionally diagnosed in neck dissection specimens. Their importance has begun to be recognized, however, their value has not been investigated in laryngeal cancer as a single tumor site. Objective: To investigate the prognostic value of soft tissue deposits in patients with laryngeal carcinoma. Methods: Medical records of 194 patients with laryngeal carcinoma who were treated primarily by surgery and neck dissection were reviewed. Prognostic significance of soft tissue deposits was assessed along with other clinical and pathological findings. Recurrence rates, overall and disease-specific survival rates were examined. Results: The incidence of soft tissue deposits was found to be 7.2% in laryngeal carcinoma. N stage was more advanced in patients who had soft tissue deposits. Regional recurrence rate was higher and disease specific and overall survivals rates were significantly lower in patients with soft tissue deposits in univariate analysis. However, in multivariate analysis, soft tissue deposits were not found as an independent risk factor. Conclusion: In laryngeal carcinoma, soft tissue deposits was diagnosed in patients with more advanced neck disease and their significance was lesser than other factors including extranodal extension.Resumo Introdução: Depósitos de tecido mole são ilhas tumorais diferente dos linfonodos e ocasionalmente diagnosticados em amostras de esvaziamento cervical. Sua importância começou a ser reconhecida, mas seu valor não foi investigado no câncer de laringe como um único local de tumor. Objetivo: Investigar o valor prognóstico do depósito de tecido mole em pacientes com carcinoma laríngeo. Método: Os prontuários de 194 pacientes com carcinoma laríngeo tratados principalmente por cirurgia e esvaziamento cervical foram analisados. O significado prognóstico dos depósitos de tecido mole foi avaliado juntamente com outros achados clínicos e histopatológicos. As taxas de recidiva, as taxas de sobrevida geral e específicas da doença foram avaliadas. Resultados: Observou-se uma incidência de depósitos de tecido mole de 7,2% no carcinoma laríngeo. O estágio N foi mais avançado em pacientes com depósitos de tecido mole. A taxa de recorrência regional foi maior e as taxas de sobrevida geral e específica da doença foram significativamente menores nesses pacientes na análise univariada. No entanto, na análise multivariada, o depósito de tecido mole não foi observado como um fator de risco independente. Conclusão: No carcinoma laríngeo, o depósito de tecido mole foi diagnosticado em pacientes com doença cervical mais avançada, mas sua significância foi menor do que outros fatores, inclusive a extensão extranodal

Prognostic factors in larynx cancer and the prognostic value of free tumor implants

Larenks kanserlerinde prognozun tespitinde TNM sınıflaması kullanılmakla birlikte TNM dışında prognostik faktörler de mevcuttur. Bu çalışmanın amacı larenks kanserlerindeki bilinen prognostik faktörlerin öneminin belirlenmesi ve rutin olarak kullanılmayan serbest tümör implantlarının (STİ) prognostik öneminin ortaya konulmasıdır. Ocak 2007 ile Aralık 2013 tarihleri arasında yassı epitel hücreli (YEH) larenks kanseri tanısıyla primer cerrahi tedavi uygulanıp boyun diseksiyonu yapılan hastaların dosyaları retrospektif olarak tarandı. Hastaların demografik bilgileri, klinik ve patolojik prognostik faktörleri; ek tedavileri, takip süreleri, nüks/metastaz gelişimi ve son durumları kaydedildi. Diğer prognostik faktörlerin STİ ile ilişkileri ve prognostik faktörlerin tek değişkenli ve çok değişkenli modeller kullanılarak hastalıksız sağkalım ve genel sağkalım üzerindeki etkileri araştırıldı. Toplam 201 hastanın ortalama takip süresi 37,74±27,0 aydı. Lokorejyonel nüks toplam 24 (%11,9), uzak metastaz 13 (%6,5) hastada tespit edildi. Takip sırasında ölen 57 (%28,3) hastanın 30'u (%15,4) tümörden kaybedildi. STİ 15 (%7.5) hastada tespit edildi. STİ olan ve olmayan hastalar arasında klinik evre (p=0,015), klinik N sınıflaması (p<0,001), patolojik N sınıflaması (p<0,001) ve boyun diseksiyonu tipi (p<0,001) anlamlı değişkenler olarak görüldü. STİ olan vakalarda ekstrakapsüler yayılımın (EKY) (p=0,002), konglomere lenfadenopatinin (LAP) (p<0,001), perinöral invazyon (PNİ) (p=0,002) ve vasküler invazyonunun (Vİ) (p<0,001) daha sık olduğu görüldü. STİ bulunan hastalarda genel sağkalımın, STİ bulunmayanlara göre anlamlı derecede düşük olduğu görüldü. (p=0,004) Tek değişkenli analizde patolojik N evresi, PNİ, EKY, boyun diseksiyonu tipi, lokal nüksün ve uzak metastazın hastalığa özgü sağkalımda ve genel sağkalımda anlamlı değişikliğe neden olduğu görüldü. Konglomere LAP'nin genel sağkalımda anlamlı değişikliğe neden olduğu görüldü. Cerrahi sınırın ve sigaranın hastalığa özgü sağkalımda anlamlı değişikliğe neden olduğu görüldü. Çok değişkenli analiz yapıldığında hastalığa özgü sağkalımda STİ, EKY ve lokorejyonel nüks; genel sağkalımda ise sadece PNİ ve lokorejyonel nüks değişkenlerinin anlamlı değişiklik yaptıkları izlendi. Cox regresyon analizi ile STİ'nın hastalığa özgü sağkalımda ölüm riskini 4,6 kat ve EKY'ın ise ölüm riskini 3,3 kat arttırdığı görüldü. Cox regresyon analizinde perinöral invazyonun genel sağkalımda ölüm riskini 2,3 kat arttırdığı görüldü. Larenks kanserlerinde STİ hastalığa bağlı ölüm riskini 4,6 kat arttıran bağımsız bir prognostik faktör olarak bulunmuştur. STİ dışında EKY, PNİ gibi faktörler de TNM evrelemesinde kullanılmayan bağımsız prognostik faktörler olarak ortaya konulmuştur. Larenks kanserlerinin boyun spesimenlerinin incelenmesinde STİ rutin olarak değerlendirilmelidir. STİ'nın larenks kanseri tedavi algoritmalarında dikkate alınması gerektiğini ancak bu konunun daha iyi anlaşılması için prospektif çalışmalara ihtiyaç olduğunu düşünmekteyiz.TNM classification is used in determination of prognosis of larynx cancers but there are other prognostic factors also. The aim of this study was to determine the significance of known prognostic factors in larynx cancers and reveal the prognostic value of free tumor implants (FTI) which are not surveyed routinely. A retrospective chart review was performed to identify patients who were treated surgically and underwent neck dissection as the primary treatment with the diagnosis of laryngeal squamous cell carcinoma between January 2007 and December 2013. The demographic data, clinical and pathological prognostic factors, adjuvant treatments, follow up durations, development of recurrence/metastasis and final outcomes of the patients were recorded. Relationships between FTI and other prognostic factors, and the influence of prognostic factors on disease free and overall survival rates were investigated by using univariate and multivariate analysis. Mean follow up duration of 201 patients was 37.74±26.98 months. Twenty-four (11.9%) patients had loco-regional recurrence and 13 (6.5%) had developed distant metastasis. Thirty (15.4%) of 57 patients (28.3%) who died during follow up were related to tumor. FTI was identified in 15 (7.5%) patients. Clinical stage (p=0.015), clinical N classification (p<0.001), pathological N classification (p<0.001) and type of neck dissection (p<0.001) were found to be significant variables between patients diagnosed with or without FTI. Cases with FTI had extra-capsular spread (ECS) (p=0.002), conglomerated lymphadenopathy (LAP) (p<0.001), perineural invasion (PNI) (p=0.002) and vascular invasion (VI) (p<0.001) more frequently. Overall survival of cases with FTI was found to be significantly shorter compared to patients without FTI. (p=0.004) In univariate analysis pathological N stage, PNI, ECS, type of neck dissection, local recurrence and distant metastasis were found to have significant effect on disease specific and overall survival. Conglomerated LAP caused significant difference on overall survival. Surgical margin and smoking were found to have significant effect to disease specific survival. When multivariate analysis was applied, FTI, ECS and loco-regional recurrence were found to have significant impact on disease specific survival whereas, only PNI and loco-regional recurrence were important for overall survival. Cox regression analysis of disease specific survival revealed that, FTI and ECS increased the mortality 4.6 and 3.3 times respectively. PNI increased mortality 2.3 times Cox regression analysis of overall survival. FTI was found as an independent prognostic factor which increased mortality rate 4.6 times in disease specific survival in larynx cancer. Beside the FTI; factors like ECS and PNI, which are not employed in TNM classification, have been demonstrated as independent prognostic factors. FTI should be assessed routinely in examination of neck specimens in larynx cancers. We concluded that FTI should be taken into consideration in treatment algorithms of larynx cancer however; further prospective studies are necessary for better realization of the subject

Equipment selection based on two different fuzzy multi criteria decision making methods: Fuzzy TOPSIS and fuzzy VIKOR

Deciding on equipment from a set of feasible alternatives for excavation purpose in open pit mines is a critical task for the engineers and contractors since it considerably affects the project costs and productivity. Alternatives of rock excavation equipment, which are deemed suitable for the diggability of rock units in open pits, can have many technical specifications or factors that should be considered simultaneously. It can be successfully selected in a scientific way by employing multi-criteria decision making methods by means of taking the advantage of engineering knowledge, intuition and past experiences. In this study, we select the most convenient hydraulic excavator for a magnesite mine by fuzzy multi criteria decision making methods: fuzzy TOPSIS and fuzzy VIKOR. The fuzzy approach allows the experienced engineers to compare the multiple criteria (technical factors) and the possible alternatives of rock excavation machines by simply using linguistic expressions in their natural language

Analysis of Risk Factors Associated with Candidemia Among Patients with or without COVID-19 in Intensive Care Units During the Pandemic Process: A Multicenter Study

Introduction: The objective of this study was to compare the risk factors and mortality rates of candidemia among patients with and without COVID-19 in the intensive care units (ICU). Materials and Methods: This study is a retrospective multicenter observational study, in ICUs of 12 hospitals (eight tertiary and four secondary hospitals) in Türkiye. All adult patients (>18 years) hospitalized in ICUs and developed candidemia between 01.01.2020- 31.12.2021 were included. The following data were collected: age, gender, nasopharyngeal swab SARS-CoV-2 PCR test, species of Candida (Candida albicans or non-albicans Candida), comorbidities, ICU stay, antibiotic use, corticosteroid, and anti-cytokine therapy, central venous catheter (CVC), abdominal surgery, parenteral nutrition, mechanical ventilation (MV), other cultures isolated Candida spp., echocardiography (ECO), mortality. Data from patients with or without COVID-19 were compared. Results: A total of 188 patients, 66 COVID-19 and 122 non-COVID-19, were included in the study. The median age of the patients was 69.5 and there were no differences between the groups. 185 (98.4%) patients had a history of antibiotic use. Sixteen patients, all from the COVID-19 group, had a history of anti-cytokine therapy. Corticosteroid use was higher in COVID-19 patients (p< 0.001). Intraabdominal surgery was higher in the non-COVID-19 group (p< 0.014). C. albicans was isolated from 36.7% of total patients and the remaining were non-albicans Candida species. The overall mortality was higher in COVID-19 patients (p= 0.014). Alzheimer’s and malignancies were higher in non-COVID-19 patients. Intraabdominal surgery, MV, and CVC were higher in tertiary care hospitals whereas parenteral nutrition was higher in secondary care hospitals. Conclusion: Immunosuppressive treatments administered to COVID-19 patients pose a risk in terms of candidemia. Risk factors may differ between secondary and tertiary care hospitals. Preventable risk factors should be determined on a hospital basis and appropriate infection control measures should be taken

Latent Tuberculosis Infection Management in Solid Organ Transplantation Recipients: A National Snapshot

OBJECTIVE: Latent tuberculosis infection (LTBI) screening is strongly recommended in the pre-transplant evaluation of solid organ transplant (SOT) recipients, although it remains inadequate in many transplant centers. We decided to investigate pre-transplant TB risk assessment, LTBI treatment, and registry rates in Türkiye. MATERIAL AND METHODS: Adult SOT recipients who underwent tuberculin skin test (TST) and/or interferon-gamma release test (IGRA) from 14 centers between 2015 and 2019 were included in the study. An induration of ≥5 mm on TST and/or probable/positive IGRA (QuantiFERON-TB) was considered positive for LTBI. Demographic features, LTBI screening and treatment, and pre-/post-transplant TB history were recorded from the electronic database of transplantation units across the country and pooled at a single center for a unified database. RESULTS: TST and/or IGRA were performed in 766 (33.8%) of 2266 screened patients most of whom were kidney transplant recipients (n = 485, 63.4%). LTBI screening test was positive in 359 (46.9%) patients, and isoniazid was given to 203 (56.5%) patients. Of the patients treated for LTBI, 112 (55.2%) were registered in the national registry, and 82 (73.2%) completed the treatment. Tuberculosis developed in 6 (1.06%) of 563 patients who were not offered LTBI treatment. CONCLUSION: We determined that overall, only one-third of SOT recipients in our country were evaluated in terms of TB risk, only 1 of the 2 SOT recipients with LTBI received treatment, and half were registered. Therefore, we want to emphasize the critical importance of pre-transplant TB risk stratification and registration, guided by revised national guidelines

Quality of life and related factors among chronic hepatitis B-infected patients: a multi-center study, Turkey

Background: The aim of this study was to assess health-related quality of life (HRQOL) among chronic hepatitis B (CHB) patients in Turkey and to study related factors

Quality of life and related factors among chronic hepatitis B-infected patients: a multi-center study, Turkey

balkan, ilker inanc/0000-0002-8977-5931; Altindis, Mustafa/0000-0003-0411-9669; Sahin, Ahmet Ziyaettin/0000-0003-1060-6746; atilla, aynur/0000-0001-8027-1991WOS: 000386954300001PubMed: 27809934Background: The aim of this study was to assess health-related quality of life (HRQOL) among chronic hepatitis B (CHB) patients in Turkey and to study related factors. Methods: This multicenter study was carried out between January 01 and April 15, 2015 in Turkey in 57 centers. Adults were enrolled and studied in three groups. Group 1: Inactive HBsAg carriers, Group 2: CHB patients receiving antiviral therapy, Group 3: CHB patients who were neither receiving antiviral therapy nor were inactive HBsAg carriers. Study data was collected by face-to-face interviews using a standardized questionnaire, Short Form-36 (SF-36) and Hepatitis B Quality of Life (HBQOL). Values equivalent to p < 0.05 in analyses were accepted as statistically significant. Results: Four thousand two hundred fifty-seven patients with CHB were included in the study. Two thousand five hundred fifty-nine (60.1 %) of the patients were males. Groups 1, 2 and 3, consisted of 1529 (35.9 %), 1721 (40.4 %) and 1007 (23.7 %) patients, respectively. The highest value of HRQOL was found in inactive HBsAg carriers. We found that total HBQOL score increased when antiviral treatment was used. However, HRQOL of CHB patients varied according to their socio-demographic properties. Regarding total HBQOL score, a higher significant level of HRQOL was determined in inactive HBV patients when matched controls with the associated factors were provided. Conclusions: The HRQOL score of CHB patients was higher than expected and it can be worsen when the disease becomes active. Use of an antiviral therapy can contribute to increasing HRQOL of patients