Purpose
We aim to compare the efficiency and toxicity of three different 5-fluorouracil (5-FU) administration types in 5-FU, leucovorin, and oxaliplatin (FOLFOX) combination treatment for adjuvant ...therapy in colorectal cancer (CRC).
Methods
Five hundred and seventy patients with stage III colorectal carcinoma who received different FOLFOX regimens after curative resection were included. Patients were divided into three groups as FOLFOX-4, modified FOLFOX-6 (mFOLFOX-6), and mFOLFOX-4 for comparison of toxicity and disease-free survival (DFS) and overall survival (OS) times.
Results
Three-year DFS rates for FOLFOX-4, mFOLFOX-6, and mFOLFOX-4 groups were 65%, 72%, and 72%, respectively. Five-year OS rates for FOLFOX-4, mFOLFOX-6, and mFOLFOX-4 groups were 69%, 75%, and 67%, respectively. There was no statistically significant difference between the three treatment groups in terms of DFS and OS (
p
= 0.079, and
p
= 0.147, respectively). Among grade 1–2 adverse events (AE), thrombocytopenia, neuropathy, and stomatitis were more common in the mFOLFOX-6-treated group. The frequency of grade 1–2 nausea and vomiting were similar in mFOLFOX-6 (36.3% and 24%, respectively) and mFOLFOX-4 (32.4% and 24.7%, respectively) groups but were higher than that in the FOLFOX-4 (19.5% and 11.3%, respectively) group. Among the most common grade 3–4 AE, neutropenia (53.4%, 9%, and 13.5%, respectively) and diarrhea (10.5%, 2.2%, and 2.4, respectively) were more common in FOLFOX-4. The rate of anemia and febrile neutropenia was similar in treatment groups (
p
= 0.063, and
p
= 0.210, respectively).
Conclusion
In the adjuvant treatment of stage III CRC patients, three different 5-FU administration types in FOLFOX combination treatment can be used with similar efficiency and manageable toxicity.
Central nervous system (CNS) metastases can be seen at a rate of 30% in advanced stages for patients with non-small cell lung cancer (NSCLC). Growing evidence indicates the predictive roles of driver ...gene mutations in the development of brain metastases (BM) in recent years, meaning that oncogene-driven NSCLC have a high incidence of BM at diagnosis. Today, 3rd generation targeted drugs with high intracranial efficacy, which can cross the blood-brain barrier, have made a positive contribution to survival for these patients with an increased propensity to BM. It is important to update the clinical and pathological factors reflected in the survival with real-life data. A multi-center, retrospective database of 306 patients diagnosed with driver mutant NSCLC and initially presented with BM between between November 2008 and September 2022 were analyzed. The median progression-free survival (mPFS) was 12.25 months (95% CI, 10-14.5). While 254 of the patients received tyrosine kinase inhibitor (TKI), 51 patients received chemotherapy as first line treatment. The median intracranial PFS (iPFS) was 18.5 months (95% CI, 14.8-22.2). The median overall survival (OS) was 29 months (95% CI, 25.2-33.0). It was found that having 3 or less BM and absence of extracranial metastases were significantly associated with better mOS and iPFS. The relationship between the size of BM and survival was found to be non-significant. Among patients with advanced NSCLC with de novo BM carrying a driver mutation, long-term progression-free and overall survival can be achieved with the advent of targeted agents with high CNS efficacy with more conservative and localized radiotherapy modalities.
The aim of the study is to compare the efficacy and safety of 3 chemotherapy regimens used as first-line treatments in the real-life management of metastatic pancreatic cancer.
A total of 218 ...patients were included in this multicenter study. Gemcitabine (Gem, n = 71), gemcitabine-cisplatin (Gem-Cis, n = 91), and FOLFIRINOX (a combination of leucovorin, 5-fluorouracil, irinotecan, and oxaliplatin FFX, n = 56) treatments were compared.
Overall response rate was significantly higher in the FFX group (50.0%) than in the Gem (28.2%) and Gem-Cis (27.5%) groups (P = 0.010). Median progression-free survival (8.4 vs 4.6 and 5.5 months, respectively, P < 0.001) and overall survival (16.4 vs 8.1 and 8.7 months, respectively, P = 0.002) were significantly longer in the FFX group than in the Gem and Gem-Cis groups. Toxicity of any grade was noted in 46 (64.8%), 56 (61.5%), and 49 (87.5%) patients in the Gem, Gem-Cis, and FFX groups, respectively (P = 0.003).
In our study, FFX regimen provides a significant advantage over the other treatment regimens in terms of response rates and survival. Treatment toxicity was more frequent but manageable with the FFX regimen.
Identifying crowding norms is a crucial part of modern management frameworks intended to assist in protecting park resources and the quality of the visitor experience. Determining the factors ...affecting perceived crowding is a subject that has always been emphasized by park and protected area managers and researchers. Experience is typically regarded as having previously visited the area or engaged in an activity in prior literature. This study aims to analyze the potential effects of “experience” in determining crowding, based on visual research methods, from a perspective other than the two approaches in the literature. A quasi-experimental research design was applied to the study. Eleven images created with photography techniques were presented to 32 voluntary participants for data collection. According to the findings, participants had different perceptions about crowding before and after the activity, and at the end of the interviews conducted to understand the reasons for this difference, “enjoy” was determined as the main underlying cause. As a result, it is suggested that personal experiences about the activity should be considered in norm-determining studies.
Plain Language Summary This study aims to analyze the potential effects of “experience” in determining crowding, based on visual research methods, from a perspective other than the two approaches in the literature. A quasi-experimental research design was applied to the study. Eleven images created with photography techniques were presented to 32 voluntary participants for data collection. According to the findings, participants had different perceptions about crowding before and after the activity, and at the end of the interviews conducted to understand the reasons for this difference, “enjoy” was determined as the main underlying cause. As a result, it is suggested that personal experiences about the activity should be considered in norm-determining studies.
Reklam okuryazarlığı, çocukların maruz kaldıkları her türlü medya içeriklerinin (televizyon, Youtube, İnstagram, Facebook vb.) olumsuz yönlerinden kendilerini korumaları için sahip olmaları gereken ...en önemli okuryazarlık türlerinden biridir. Reklam okuryazarlığı geleneksel görüşe göre çocuklar için bir tür filtre işlevine sahiptir. Bilişsel görüşe göre ise çocuklar sahip oldukları eleştirel bakışla kendi istek ve ihtiyaçlarına göre izleyecekleri reklama karar verme kabiliyeti kazanmaktadır. Ancak söz konusu ikinci görüşün işlevini alan yazında kanıtlayacak deneysel çalışmaların olmadığını tespit eden alan uzmanları reklam okuryazarlığı kavramını yeniden düşünmüşlerdir. Bu düşünme çerçevesinde, reklam okuryazarlığı becerisini “kavramsal reklam okuryazarlığı, reklam okuryazarlığı performansı ve tutumsal reklam okuryazarlığı” olmak üzere üç boyutlu bir biçimde tasarlamışlardır. Onlara göre söz konusu üç boyuttan üzerinde durulması gereken boyut, tutumsal reklam okuryazarlığıdır. Çünkü tutumsal reklam okuryazarlığı çocukların reklamlara karşı vereceği tepkide önemli roller oynamaktadır. Kısacası, tutumsal reklam okuryazarlığı kavramsal reklam okuryazarlığı bilgilerini ve performanslarını etkileyen en önemli etkenlerdendir. Bu bağlamda, araştırmanın amacı; ülkemizdeki ortaokul öğrencilerinin reklam okuryazarlığı konusundaki tutumları ile sınıf düzeyleri arasında anlamlı bir farklılaşmanın olup olmadığını incelemektir. Araştırma, nicel araştırma yaklaşımlarından tarama modeline göre desenlenmiştir. Araştırmada, veri toplama aracı olarak Rozendaal vd. (2014) tarafından geliştirilen Tutumsal Reklam Okuryazarlığı Ölçeği kullanılmıştır. Ön yargı, Şüphe ve Beğeni olmak üzere 3 boyuttan oluşan ölçeğin güvenirlik katsayısı Rozendaal (2014) tarafından .71 olarak tespit edilmiştir. Bizim çalışmamızda ise ölçeğin genel güvenirlik katsayısı .73, Ön Yargı, Şüphe ve Beğeni boyutları için ise sırasıyla .72, .74 ve .82 olarak tespit edilmiştir. Söz konusu ölçek, ülkemizde ortaokul kademesinde eğitim-öğretimine devam eden 5, 6 ve 7. sınıf öğrencilerine çevrim içi anket formunda uygulanmıştır. Anket verilerinin analizlerinden elde edilen bulgulara göre; ortaokul öğrencilerinin reklam okuryazarlığı tutumlarının Ön Yargı, Şüphe ve Beğeni düzeylerinin ortalamalarının sınıf düzeyine göre değiştiği; ancak tespit edilen farklılaşmanın istatistiki olarak anlamlı olmadığı sonucuna ulaşılmıştır.
Advertising literacy is one of the most significant types of literacy that children should have in order to protect themselves from the negative aspects of all kinds of media content (television, Youtube, Instagram, Facebook, etc.) they are exposed to. According to the traditional view, advertising literacy functions as a kind of filter for children. According to the cognitive view, children have the ability to decide on the advertisement that they will watch based on their own wishes and needs with their critical view. However, field experts who found out that there were no experimental studies to prove the function of the second opinion in the literature reconsidered the concept of advertising literacy. Thus, they designed the advertising literacy skill under three dimensions as "conceptual advertising literacy, advertising literacy performance and attitudinal advertising literacy". Attitudinal advertising literacy is regarded by the experts to be the most significant dimension of all since it plays crucial roles in children's reaction to advertisements. In short, attitudinal advertising literacy is one of the most important factors affecting conceptual advertising literacy knowledge and performance. The current study aims to examine whether there is a significant difference between the attitudes of secondary school students in Turkey towards advertising literacy and their grade levels. The study was designed according to the survey model, which is one of the quantitative research approaches. In this survey research, the Attitudinal Advertising Literacy Scale developed by Rozendaal et al. (2014) was employed as a data collection tool. The reliability coefficient of the scale, which consists of 3 dimensions as Prejudice, Suspicion and Admiration, is .71. In our study, the overall reliability coefficient of the scale was determined as .73, and for the dimensions of Prejudice, Doubt, and Admiration as .72, .74 and .82, respectively. The scale was applied to the 5th, 6th and 7th-grade students attending secondary school in Turkey in an online questionnaire form. The findings display that the means of prejudice, suspicion and admiration levels of secondary school students' advertising literacy attitudes vary according to the grade level; however, it was concluded that the difference was not statistically significant.
•Lorlatinib is highly extracranial (EC) and intracranial (IC) effective for ALK+ or ROS1+ in advanced NSCLC.•Response rates (RR) of EC 60% and IC 62% for ALK + and EC and IC RR of 62% and 67% for ...ROS1+, respectively.•Mean duration of therapy (DoT) for ALK + was 23.9 ± 1.6 months and median overall survival (mOS) 89.1 ± 19.6 months.•ROS1 + cohort had a median DoT of 18.1 ± 2.5 months and mOS of 90.3 ± 24.4 months.
Lorlatinib is a third-generation tyrosine-kinases inhibitor (TKI) targeting ALK/ROS1 fusions. The FDA has approved lorlatinib for TKI-pretreated ALK(+) NSCLC, while its approval for ROS1(+) is still pending. Here we present the largest real-world data of NSCLC patients harboring ALK/ROS1 rearrangements treated with lorlatinib.
123 patients were enrolled retrospectively (data cut-off 1/1/2019). Lorlatinib was administered through an early access program for patients with no other available therapy. Outcome and response were defined by each investigator upon RECIST 1.1 criteria.
106 ALK(+) and 17 ROS1(+) patients recruited from 8 different countries. The ALK(+) cohort included 50 % males, 73 % never-smokers and 68 % with brain metastases. Extracranial (EC) and intracranial (IC) response rates (RR) were 60 % and 62 %, with disease control rates (DCR) of 91 % and 88 % respectively. Mean duration of therapy (DoT) was 23.9 ± 1.6 months and median overall survival (mOS) was 89.1 ± 19.6 months. ROS1 cohort enrolled 53 % males, 65 % never-smokers and 65 % had brain metastases. EC and IC RR were 62 % and 67 % with DCR of 92 % and 78 % respectively. Median DoT was 18.1 ± 2.5 months and mOS of 90.3 ± 24.4 months. OS and DoT in both cohorts were not significantly correlated with line of therapy nor other parameters.
The most common adverse events of any grade were peripheral edema (48 %), hyperlipidemia (47 %), weight gain (25 %) and fatigue (30 %). CNS adverse events such as cognitive effect of grade 1–2 were reported in 18 % of patients.
Lorlatinib shows outstanding EC/IC efficacy in ALK/ROS1(+) NSCLC. The observed mOS of 89 ± 19 months in ALK(+) NSCLC supports previous reports, while mOS from of 90 ± 24 months is unprecedented for ROS1(+) NSCLC.
AIM： To identify the frequency of bacterial growth, the most commonly grown bacteria and their antibiotic susceptibility, and risk factors for bacterial colonization in bile collected from patients ...with different biliary dis- eases. METHODS： This prospective study was conducted be- tween April 2010 and August 2011. Patients with vari- ous biliary disorders were included. Bile was aspirated by placing a single-use, 5F, standard sphincterotome catheter into the bile duct before the injection of con- trast agent during endoscopic retrograde cholangio- pancreaticography （ERCP）. Bile specimens were trans- ported to the microbiology laboratory in blood culture bottles within an anaerobic transport system. Bacteria were cultured and identified according to the standard protocol used in our clinical microbiology laboratory. The susceptibilities of the organisms recovered were identified using antimicrobial disks, chosen according tothe initial gram stain of the positive cultures RESULTS： Ninety-one patients （27% male, mean age 53.7 4- 17.5 years, range： 17-86 years） were included in the study. The main indication for ERCP was benign biliary disease in 79 patients and malignant disease in 12 patients. The bile culture was positive for bacterial growth in 46 out of 91 （50.5%） patients. The most frequently encountered organisms were Gram-negative bacteria including Escherich/a coli （28.2%）, Pseudo- monas （17.3%） and Stenotrophomonas rnaltophilia （15.2%）. There were no significant differences between patients with malignant and benign disease （58% vs 49%, P = 0.474）, patients with acute cholangitis and without acute cholangitis （52.9% vs 50%, P = 0.827）, patients who were empirically administered antibiotics before intervention and not administered （51.4% vs 60.7%, P = 0.384）, with regard to the bacteriobilia. We observed a large covering spectrum or low resistance to meropenem, amikacin and imipenem. CONCLUSION： We did not find a significant risk fac- tor for bacteriobilia in patients with biliary obstruction. A bile sample for microbiological analysis may become a valuable diagnostic tool as it leads to more accurate selection of antibiotics for the treatment of cholangitis.
Pleural mesothelioma (PM) is a cancer of the pleural surface, which is aggressive and may be rapidly fatal. PM is a rare cancer worldwide, but is a relatively common disease in Turkey. Asbestos ...exposure is the main risk factor and the most common underlying cause of the disease. There have been significant improvements in diagnoses and treatments of many malignancies; however, there are still therapeutic challenges in PM. In this review, we aimed to increase the awareness of health care professionals, oncologists, and pulmonologists by underlining the unmet needs of patients with PM and by emphasizing the need for a multidisciplinary treatment and management of PM. After reviewing the general information about PM, we further discuss the treatment options for patients with PM using immunotherapy and offer evidence for improvements in the clinical outcomes of these patients because of these newer treatment modalities.
The aim of this study was to measure the volume of interscalene space in thoracic outlet region on cadavers and radiological images and to analyze the potential value of these measurements in ...diagnosis and treatment of thoracic outlet syndrome (TOS).
The dimensions of the anterior interscalene space in 8 formalin-fixed human cadavers were studied by direct measurement and additionally evaluation of the volume of this space were done by using mold and volume calculation formula of square pyramid, due to resembling a pyramid. In the second phase of this study, interscalene space volume was calculated by formula and compared to calculations from computed tomography (CT) sections in 18 TOS and 16 control patients.
There was a strong correlation between the volume calculated by formula (4.79 ± 2.18 cm3) and by mold (4.84 ± 1.58 cm3), (R = 0.934, p = 0.001) in cadavers. The average volume measured in TOS patients (2.05 ± 0.32 cm3) was significantly smaller than control patients (4.30 ± 1.85 cm3, p < 0.0001). There were excellent or good results in 14 patients whereas in 4 patients who had neurogenic TOS achieved fair results after surgery. In these 4 patients the average volumes of abnormal sides were close to the healthy sides.
In our study, volume of interscalene space in TOS patients was statistically smaller than control group. Also, the volume was even smaller in patients with excellent or good results after surgery. In this respect, volumetric measurements from CT sections could be used in diagnosis and treatment selection in TOS patients.
Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia worldwide and is associated with an increased risk of thromboembolism, ischemic stroke, impaired quality of life, and mortality. The ...latest research that shows the prevalence and incidence of AF patients in Türkiye was the Turkish Adults' Heart Disease and Risk Factors study, which included 3,450 patients and collected data until 2006/07.The Turkish Real Life Atrial Fibrillation in Clinical Practice (TRAFFIC) study is planned to present current prevalence data, reveal the reflection of new treatment and risk approaches in our country, and develop new prediction models in terms of outcomes.
The TRAFFIC study is a national, prospective, multicenter, observational registry. The study aims to collect data from at least 1900 patients diagnosed with atrial fibrillation, with the participation of 40 centers from Türkiye. The following data will be collected from patients: baseline demographic characteristics, medical history, vital signs, symptoms of AF, ECG and echocardiographic findings, CHADS2-VASC2 and HAS-BLED (1-year risk of major bleeding) risk scores, interventional treatments, antithrombotic and antiarrhythmic medications, or other medications used by the patients. For patients who use warfarin, international normalized ratio levels will be monitored. Follow-up data will be collected at 6, 12, 18, and 24 months. Primary endpoints are defined as systemic embolism or major safety endpoints (major bleeding, clinically relevant nonmajor bleeding, and minor bleeding as defined by the International Society on Thrombosis and Hemostasis). The main secondary endpoints include major adverse cardiovascular events (systemic embolism, myocardial infarction, and cardiovascular death), all-cause mortality, and hospitalizations due to all causes or specific reasons.
The results of the 12-month follow-up of the study are planned to be shared by the end of 2023.
The TRAFFIC study will reveal the prevalence and incidence, demographic characteristics, and risk profiles of AF patients in Türkiye. Additionally, it will provide insights into how current treatments are reflected in this population. Furthermore, risk prediction modeling and risk scoring can be conducted for patients with AF.
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