A non-randomized comparison of gemcitabine-based chemoradiation with or without induction chemotherapy for locally advanced squamous cell carcinoma of the head and neck

<p>Abstract</p> <p>Background</p> <p>Concomitant chemotherapy and radiotherapy (chemoradiation; CRT) is the standard treatment for locoregionally advanced squamous cell carcinoma of the head and neck (LA-SCCHN). CRT improves local control and overall survival (OS) when compared to radiotherapy (RT) alone. Induction chemotherapy (IC) reduces the risk of distant metastases (DM) and improves OS by 5% with the use of cisplatin/infusional 5 fluorouracil (PF) in meta-analysis. Adding a taxane to PF in the IC regimen confers a better outcome. Sequential treatment (ST) of IC followed by CRT is therefore under active investigation in multiple phase III trials.</p> <p>Methods</p> <p>We compared the outcome of two cohorts of patients (pts) with LA-SCCHN treated at our institution with CRT (n = 27) or ST (n = 31), respectively. CRT consisted of GEM 100 mg/m²weekly + conventional RT (70 Gy); ST consisted of the same CRT preceded by platinum-based IC.</p> <p>Results</p> <p>Response to IC: complete 8 (26%), partial 20 (65%), stable 1, progressive 1, not evaluable 1. Median follow up of the surviving pts: for CRT 73 months, for ST 51 months. Median time to distant metastasis (TDM) was for CRT 23.6 months, for ST not reached. Median OS was for CRT 20.2 months, for ST 40.2 months. Cox regression analysis, taking into account age, T and N stage and tumor site, showed a hazard ratio with ST of 1.190 for time to locoregional failure (p = 0.712), 0.162 for TDM (p = 0.002), and 0.441 for overall survival (OS) (p = 0.026).</p> <p>Conclusion</p> <p>TDM and OS were found significantly longer in the ST cohort without a reduced locoregional control. Notwithstanding the limitations of a non-randomized single-center comparison, the results are in line with very preliminary data of randomized comparisons suggesting an improved outcome with ST.</p

Low CD10 mRNA Expression Identifies High-Risk Ductal Carcinoma In Situ (DCIS)

PURPOSE: Optimal management of breast ductal carcinoma in situ (DCIS) is controversial, and many patients are still overtreated. The local death of myoepithelial cells (MECs) is believed to be a pre-requisite to tumor invasion. We thus hypothesized that loss of CD10 expression, a MEC surface peptidase, would signify basement membrane disruption and confer increased risk of relapse in DCIS. The aim of our study was to retrospectively evaluate the prognostic value of CD10 in DCIS. EXPERIMENTAL DESIGN: CD10 expression was evaluated by quantitative RT-PCR and immunohistochemistry using paraffin-embedded samples of normal breast tissue (n = 11); of morphologically normal ducts associated with DCIS (n = 10); and of DCIS without an invasive component (n = 154). RESULTS: CD10 immunostaining was only observed in MECs in normal tissue and in DCIS. Normal tissue showed high mRNA expression levels of CD10, whereas DCIS showed a variable range. After a median follow-up of 6 years, DCIS with CD10 expression below the levels observed in normal tissue (71%) demonstrated a higher risk of local relapse (HR = 1.88; [95CI:1.30-2.70], p = 0.001) in univariate analysis. No relapse was observed in patients expressing high CD10 mRNA levels (29%) similar to the ones observed in normal tissue. In multivariate analysis including known prognostic factors, low CD10 mRNA expression remained significant (HR = 2.25; [95%CI:1.24-4.09], p = 0.008), as did the recently revised Van Nuys Prognostic Index (VNPI) score (HR = 2.03; [95%CI:1.23-3.35], p = 0.006). CONCLUSION: The decrease of CD10 expression in MECs is associated with a higher risk of relapse in DCIS; this knowledge has the potential to improve DCIS management

Prospective Observational Study of Pazopanib in Patients with Advanced Renal Cell Carcinoma (PRINCIPAL Study)

Background: Real-world data are essential to accurately assessing efficacy and toxicity of approved agents in everyday practice. PRINCIPAL, a prospective, observational study, was designed to confirm the real-world safety and efficacy of pazopanib in patients with advanced renal cell carcinoma (RCC). Subjects, Materials, and Methods: Patients with clear cell advanced/metastatic RCC and a clinical decision to initiate pazopanib treatment within 30 days of enrollment were eligible. Primary objectives included progression-free survival (PFS), overall survival (OS), objective response rate (ORR), relative dose intensity (RDI) and its effect on treatment outcomes, change in health-related quality of life (HRQoL), and safety. We also compared characteristics and outcomes of clinical-trial-eligible (CTE) patients, defined using COMPARZ trial eligibility criteria, with those of non-clinical-trial-eligible (NCTE) patients. Secondary study objectives were to evaluate clinical efficacy, safety, and RDI in patient subgroups. Results: Six hundred fifty-seven patients were enrolled and received ≥1 dose of pazopanib. Median PFS and OS were 10.3 months (95% confidence interval [CI], 9.2–12.0) and 29.9 months (95% CI, 24.7 to not reached), respectively, and the ORR was 30.3%. HRQoL showed no or little deterioration over time. Treatment-related serious adverse events (AEs) and AEs of special interest occurred in 64 (9.7%), and 399 (60.7%) patients, respectively. More patients were classified NCTE than CTE (85.2% vs. 14.8%). Efficacy of pazopanib was similar between the two groups. Conclusion: PRINCIPAL confirms the efficacy and safety of pazopanib in patients with advanced/metastatic RCC in a real-world clinical setting. Implications for Practice: PRINCIPAL is the largest (n = 657) prospective, observational study of pazopanib in patients with advanced/metastatic renal cell carcinoma, to the authors’ knowledge. Consistent with clinical trial results that often contain specific patient types, the PRINCIPAL study demonstrated that the effectiveness and safety of pazopanib is similarly safe and effective in patients with advanced kidney cancer in a real-world clinical setting. The PRINCIPAL study showed that patients with advanced kidney cancer who are treated with first-line pazopanib generally do not show disease progression for approximately 10 months and generally survive for nearly 30 months

Evaluation of oxidative stress parameters and metabolic activities of nurses working day and night shifts

The aim of this study was to evaluate the oxidative stress and metabolic activities of nurses working day and night shifts. Intensive care unit (ICU) (n=70) and ordinary service (OS) nurses (n=70) were enrolled in the study. Just before and the end of the shifts, blood samples were obtained to measure the participants' oxidative stress parameters. Metabolic activities were analyzed using the SenseWear Armband. Oxidative stress parameters were increased at the end of the shifts for all OS and ICU nurses compared to the beginning of the shifts. Compared to the OS nurses, the ICU nurses' TAS, TOS, and OSI levels were not significantly different at the end of the day and night shifts. The metabolic activities of the OS and ICU nurses were found to be similar. As a result, the OS and ICU nurses' oxidative stress parameters and metabolic activities were not different, and all of the nurses experienced similar effects from both the day and night shifts

Cardiac amyloidosis in a young female under follow-up with mitral regurgitation

[No Abstract Available

LOJİSTİK KÖY KURULUMUNUN LOJİSTİK HİZMET SAĞLAYICILAR AÇISINDAN DEĞERLENDİRİLMESİ: İZMİR ÖRNEĞİ

Logistics villages, as clusters which are collecting all the activities relating to logistics, are becoming important tools to gain strategic competitive advantage for the region they are located. Although they play an important role for the regional development, building logistics villages in any regions is not possible because of the high set up costs and needs for strong geographical, physical and corporate infrastructure. In Turkey, plans to construct logistics villages in specific locations including İzmir are also in progress. There are many studies in the literature about logistics villages regarding organizational structure and potential benefits there may provide. However, there is a lack of studies that consider ideas of logistics service providers as the main users of logistics villages and about construction of logistics villages in specific locations. According to the feasibility reports prepared by regional development agencies considering the ideas of logistics service providers about the location and type of services that should be offered by villages’ managements may help the village administration to increase the efficiency of villages. So as to fill this gap, in this study, the viewpoints of logistics service providers about logistics villages that are planned to be built in Izmir will be examined and suggestions will be made. Research process designed into two sections. Firstly, focused-group interview conducted and gained datas used in Fuzzy VIKOR analysis. In this study, we preferred to use fuzzy VIKOR method because of providing compromise solution for all decision makers’ utility.Sürdürülebilir büyümenin önem kazandığı günümüzde lojistik köyler, tüm lojistik faaliyetleri bir noktada toplayan kümeler olarak kuruldukları bölgeler için “stratejik rekabet avantajı” sağlamanın önemli bir aracı haline gelmiştir. Lojistik köyler bölgesel kalkınma için de önemli bir rol üstlenmiştir. Buna rağmen kurulumunun yüksek maliyetli olması ve kurulacak bölgenin coğrafi, fiziki ve kurumsal altyapısının güçlü olması gerekliliği her bölgede lojistik köy yapılanmasını mümkün kılmamaktadır. Türkiye’de İzmir’in de içinde bulunduğu belirli bölgelerde lojistik köylerin kurulması yönündeki çalışmalar devam etmektedir. Literatürde lojistik köylere ilişkin olarak, fizibilite çalışmaları kuruluş yeri seçimi, örgüt yapıları ve faydalarına yönelik çalışmalar bulunması rağmen lojistik köylerde taraf olan hizmet sağlayıcıların bulundukları bölgelerde kurulması planlanan lojistik köylere bakış açılarına yönelik çalışma bulunmamaktadır. Bununla beraber bölgesel kalkınma ajansları tarafından hazırlanmış lojistik köy fizibilite raporlarında lojistik hizmet sağlayıcılarla da görüşüldüğü bilinmektedir. Lojistik köylerde taraf olan hizmet sağlayıcıların fikirleri kurulacak lojistik köylerin sağlayabileceği verimliliği arttırmak açısından büyük önem taşımaktadır. Bu çalışmada lojistik köylerde faaliyet gösteren lojistik hizmet sağlayıcıların İzmir’de kurulması planlanan lojistik köy projelerine bakış açıları incelenecek ve bu konudaki eksiklik doldurulmaya çalışılacaktır. Araştırma iki aşamada gerçekleştirilmiştir. Öncelikle lojistik hizmet sağlayıcılar ile odak grup çalışması yapılmış elde edilen veriler bulanık vikor yöntemi uygulamasında da kullanılmıştır. Bu çalışmanın analiz kısmında bulanık vikor yöntemi kullanılması, tüm karar vericilerin faydası için uzlaştırıcı bir sonuç sağlaması nedeniyle tercih edilmiştir

Augmentation Of Antipsychotic Treatment With Memantine In Patients With Schizophrenia: A Systematic Review And Meta-Analysis

Objective: Many patients with schizophrenia respond partially to treatment with antipsychotic medications. A wide range of pharmaceutical agents are utilized as augmentation therapy in order to increase the efficacy of antipsychotic medication treatment. Memantine, a noncompetitive N-methyl-D-aspartate (NMDA) receptor antagonist is one of these add-on agents. In this study we aimed to assess the efficacy of memantine augmentation by conducting a systematic review and meta-analysis on the psychopathology of patients with schizophrenia receving antipsychotic medication. Method: We analyzed the double-blind, randomized, placebo-controlled trials of memantine add-on treatment given to schizophrenia patients receiving antipsychotic medications. The primary outcome measure was amelioration of negative symptoms and the secondary outcome measures were amelioration of positive, total and general psycopathology symptoms. Publication bias was evaluated by the Funnel plot and Egger test. Results: Eleven studies on a total of 570 cases were included. Although memantine add-on treatment was superior to placebo for ameliorating negative symptoms (SMD=0.596, 95% CI=0.075-1.118, p=0.025), there were not any statistically significant differences in the amelioration of general psycopathology (SMD=0.034, 95% CI=0.419-0.488, p=0.883), the positive (SMD=-0.041, 95% CI=0.217-0.135, p=0.650) and the overall symptoms. (SMD=0.315, 95% CI=0.256-0.887, p=0.280). Publication bias was not observed between studies according to the results of the Funnel plots and Egger tests. Conclusion: Memantine augmentation treatment is beneficial for treating particularly the negative symptoms of schizophrenia patients. Further studies on the subject with larger sample size and longer follow-up durations are needed.WoSScopu

Event-related EEG oscillatory responses elicited by dynamic facial expression

Background Recognition of facial expressions (FEs) plays a crucial role in social interactions. Most studies on FE recognition use static (image) stimuli, even though real-life FEs are dynamic. FE processing is complex and multifaceted, and its neural correlates remain unclear. Transitioning from static to dynamic FE stimuli might help disentangle the neural oscillatory mechanisms underlying face processing and recognition of emotion expression. To our knowledge, we here present the first time-frequency exploration of oscillatory brain mechanisms underlying the processing of dynamic FEs. Results Videos of joyful, fearful, and neutral dynamic facial expressions were presented to 18 included healthy young adults. We analyzed event-related activity in electroencephalography (EEG) data, focusing on the delta, theta, and alpha-band oscillations. Since the videos involved a transition from neutral to emotional expressions (onset around 500 ms), we identified time windows that might correspond to face perception initially (time window 1; first TW), and emotion expression recognition subsequently (around 1000 ms; second TW). First TW showed increased power and phase-locking values for all frequency bands. In the first TW, power and phase-locking values were higher in the delta and theta bands for emotional FEs as compared to neutral FEs, thus potentially serving as a marker for emotion recognition in dynamic face processing. Conclusions Our time-frequency exploration revealed consistent oscillatory responses to complex, dynamic, ecologically meaningful FE stimuli. We conclude that while dynamic FE processing involves complex network dynamics, dynamic FEs were successfully used to reveal temporally separate oscillation responses related to face processing and subsequently emotion expression recognition

Expectation Anchoring and Expectation Disconfirmation Hypotheses of Judicial Services: The Case of Turkey

Kamu kurumlarının daha birey merkezli ve piyasa koşullarına daha uygun hale getirilmesi amacıyla yeni kamu politikaları uygulanmaktadır. Bu politikalarda vatandaşların istek ve ihtiyaçlarını tatmin edecek doğru çıktıların sunulabilmesi amacıyla yine vatandaşların mal ve hizmetlere yönelik tercih ve talepleri belirlenmeye çalışılmaktadır. Hizmetlerin sunulduğu ülkede yaşayan bireylerin sosyo-ekonomik ve sosyo-demografik unsurlarının iyi belirlenmesi, performans göstergelerinin bu unsurlar çerçevesinde şekillendirilmesi gerekmektedir. Beklenti yanlışlaması ve beklenti çıpası yöntemleri bireylerin kamu hizmetlerden memnuniyetleri ile hizmet sunucunun performansına dair çözümlemeler sunmaktadır. Bu çalışmada TÜİK 2012 Yaşam Memnuniyeti Anket verileri kullanılarak Türkiye’de beklenti yanlışlama ve beklenti çıpası savları adalet hizmetleri özelinde test edilmiştir. 2012 yılı TÜİK tarafından Türkiye genelinde bu anketin uygulandığı son sene olması maksadıyla seçilmiştir. Bulgulara göre, Türkiye için her iki hipotezin de geçerli olduğu saptanmış ve analizler sonucunda Türk adalet hizmeti kullanıcılarının memnuniyet bazlı talep profilleri de çıkarılmıştır