European Position Paper on Rhinosinusitis and Nasal Polyps 2020

The European Position Paper on Rhinosinusitis and Nasal Polyps 2020 is the update of similar evidence based position papers published in 2005 and 2007 and 2012. The core objective of the EPOS2020 guideline is to provide revised, up-to-date and clear evidence-based recommendations and integrated care pathways in ARS and CRS. EPOS2020 provides an update on the literature published and studies undertaken in the eight years since the EPOS2012 position paper was published and addresses areas not extensively covered in EPOS2012 such as paediatric CRS and sinus surgery. EPOS2020 also involves new stakeholders, including pharmacists and patients, and addresses new target users who have become more involved in the management and treatment of rhinosinusitis since the publication of the last EPOS document, including pharmacists, nurses, specialised care givers and indeed patients themselves, who employ increasing self-management of their condition using over the counter treatments. The document provides suggestions for future research in this area and offers updated guidance for definitions and outcome measurements in research in different settings. EPOS2020 contains chapters on definitions and classification where we have defined a large number of terms and indicated preferred terms. A new classification of CRS into primary and secondary CRS and further division into localized and diffuse disease, based on anatomic distribution is proposed. There are extensive chapters on epidemiology and predisposing factors, inflammatory mechanisms, (differential) diagnosis of facial pain, allergic rhinitis, genetics, cystic fibrosis, aspirin exacerbated respiratory disease, immunodeficiencies, allergic fungal rhinosinusitis and the relationship between upper and lower airways. The chapters on paediatric acute and chronic rhinosinusitis are totally rewritten. All available evidence for the management of acute rhinosinusitis and chronic rhinosinusitis with or without nasal polyps in adults and children is systematically reviewed and integrated care pathways based on the evidence are proposed. Despite considerable increases in the amount of quality publications in recent years, a large number of practical clinical questions remain. It was agreed that the best way to address these was to conduct a Delphi exercise . The results have been integrated into the respective sections. Last but not least, advice for patients and pharmacists and a new list of research needs are included. The full document can be downloaded for free on the website of this journal: http://www.rhinologyjournal.com.

P6487Sequential combination of different thrombolytic therapy regimens in the management of patients with prosthetic valve thrombosis and stuck valves

Introduction

Prosthetic valve thrombosis (PVT) is serious complication among patients with prosthetic heart valves. Recently, thrombolytic therapy (TT) regimens with low-dose, slow and ultra-slow infusions of tissue type plasminogen activator (tPA) has been widely used as a first-line treatment for PVT. PVT with stuck valves is a special entity which deserves particular management. In our study, we aimed to investigate the effectiveness and safety of sequential combination of different TT regimens in the management of patients with PVT and stuck valves.

Methods

The study included 52 patients with PVT and stuck valves [female: 34 (65.4%), mean age: 47.5±12.4] who underwent TT with sequential combination of slow (25mg/6 hours) and ultra-slow (25mg/25 hours) infusion of low dose t-PA regimens which was mainly based on the New York Heart Association functional class of the patients according to a previously established algoritm. All patients were evaluated by cinefluoroscopy, transthoracic and transesophageal echocardiography (Figure 1).

Results

The median number of TT sessions with slow and ultra-slow infusion of tPA were 1 (0–2.75) and 3 (1.25–5) respectively. Total tPA dose was 120 (96–175) mg and TT was successful in 46 (88.4%) patients. There were 3 major complications (cerebrovascular accident: 1, intracranial bleeding: 1, gastrointestinal bleeding requiring transfusion: 1) and 6 minor complications. The in-hospital mortality rate was 1.9%. Increased thrombus area was found to be the only independent predictor of both failed TT and adverse events. Thrombus area above 1.45 cm2 predicted failed TT with a sensitivity of 83% and a specificity of 70% (AUC: 0.871; 95% CI: 0.752–0.991; p=0.003) and predicted adverse events with a sensitivity of 77% and a specificity of 73% (AUC: 0.854; 95% CI: 0.747–0.961; p=0.001). There was a moderate positive correletion between thrombus area and total tPA dose used (r=479; p<0.001).

Figure 1

Conclusion

This study demostrated that TT with sequential combination of slow and ultra-slow infusion of low dose t-PA regimens may be useful for the treatment of patients with PVT and stuck valves with acceptable success and complications rates.

Causes of Enucleation: A Clinicopathological Study

Background.

Enucleation is an approach used for unresponsive end-stage ocular disease often resulting in blind, painful or cosmetically unacceptable eyes.

Methods.

We reviewed the clinicopathological data on 3506 enucleations performed over a 50-year period, 1945-1995. Histopathological data were divided into eight groups according to the causes leading to enucleation: trauma, phthisis, corneal disease, inflammation, vitreoretinal disease, glaucoma, tumors and infections.

Results.

The study considered 3506 enucleated eyes of 3482 patients, 2467 (70.8%) males and 1011 (29.1%) females (4 sex unspecified). The z-test showed there were significantly more enucleations in males for phthisis (p<5.05), infections (p<0.01), trauma (p<0.01) and inflammation (p<0.01) and more enucleations for tumors in females (p<0.01). There were no differences between males and females with regard to enucleations for glaucoma, vitreoretinal and corneal diseases (p>0.05). The 0–9 years age group was most frequently affected, accounting for 29.7% of the cases. Patients aged less than 30 years constituted 53.6% of all enucleations. The primary or underlying causes leading to enucleation were tumors (1185 eyes, 33.8%), phthisis (587 eyes, 16.7), glaucoma (561 eyes, 16.0%), vitreoretinal diseases (320 eyes, 9.1%), infections (259 eyes, 7.4%), corneal disease (229 eyes, 6.5%), trauma (209 eyes, 6.0%) and inflammation (156 eyes, 4.4%). Time trends in enucleating eyes with different causes showed the number of enucleations for phthisis, infections, corneal diseases, trauma and inflammations had dropped during the ten-year period 1986–1995 compared to 1976–1985 (z-test, p<0.01). There were no real changes in enucleations for glaucoma and vitreoretinal diseases and there was an increase in the number of enucleations for tumors (p<0.01).

Conclusions.

Improved diagnostic and therapeutic methods, widespread use of photocoagulation in vascular disorders and vitreoretinal surgery in traumas, effective antimicrobial treatment, increasing use of corticosteroids and immunosuppressants, have contributed to the decreasing frequency of enucleation. Tumor patients generally presented late with advanced tumors totally filling the eye, not salvageable by other non-invasive treatment methods. Prompt diagnosis of intraocular malignant tumors (retinoblastoma and malignant melanoma) may reduce the need for enucleation.

Left ventricular twist in hypertrophic cardiomyopathy : Predictor of nonsustained ventricular tachycardia

BACKGROUND

We investigated the efficacy of clinical and classic echocardiographic parameters in predicting the occurrence of nonsustained ventricular tachycardia (NsVT) in patients with hypertrophic cardiomyopathy (HCM).

METHODS

The study comprised 59 patients with HCM (47 male, [80%]; mean age, 48.48 ± 14.16 years). Clinical, electrocardiographic, as well as classic two-dimensional and speckle-tracking echocardiography (STE) data were collected. All patients had Holter monitoring within 24-72 h of the echocardiographic examination. NsVT was defined as three or more consecutive premature wide QRS complexes with a heart rate of > 100 bpm. The patient population was categorized into groups based on the occurrence or absence of NsVT on the 24-h Holter recordings.

RESULTS

NsVT was observed in 17 patients (29%). In these patients, higher twist (14.4 ± 3.8 vs.18 ± 7.9; p = 0.02), higher apical rotation (8.7 ± 4.2 vs. 12.2 ± 7; p = 0.02), higher sudden cardiac death risk score (4.4 ± 2.2 vs. 7 ± 3.3; p = 0.007), and decreased global longitudinal peak strain (GLPS; -12.8 ± 3.1 vs. -10.6 ± 2.8; p = 0.014) were observed. In the multivariate logistic regression analysis, including GLPS and twist, GLPS (Odds Ratio [OR]: 1.406; 95% CI: 1.087-1.818; p = 0.009) and twist (OR: 1.236; 95% CI: 1.056-1.446; p = 0.008) were found to be independent predictors of NsVT. In the receiver operating characteristic curve analysis, GLPS < -11.9% predicted NsVT with 82% sensitivity and 60% specificity (area under the curve [AUC]: 0.70; p = 0.014) and twist > 15.2° predicted NsVT with 70% sensitivity and 58% specificity (AUC: 0.69; p = 0.027).

CONCLUSION

Decreased GLPS and increased twist were predictive of NsVT in HCM patients. Parameters that can easily be measured with STE can help detect patients who may develop arrhythmia.

24 DOF EMG controlled hybrid actuated prosthetic hand

A complete mechanical design concept of an electromyogram (EMG) controlled hybrid prosthetic hand, with 24 degree of freedom (DOF) anthropomorphic structure is presented. Brushless DC motors along with Shape Memory Alloy (SMA) actuators are used to achieve dexterous functionality. An 8 channel EMG is used for detecting 7 basic hand gestures for control purposes. The prosthetic hand will be integrated with the Neural Network (NNE) based controller in the next phase of the study.

Brain Natriuretic Peptide and the Severity of Aortic Regurgitation: Is There Any Correlation?

We aimed to evaluate the correlation between aortic regurgitation severity and brain natriuretic (BNP) levels as a marker for left ventricular dysfunction. Sixty consecutive male patients (mean age 22 ± 3 years) with isolated chronic aortic regurgitation were enrolled in the study together with a control group of 30 age-matched healthy volunteers (group A). Patients were classified with regard to aortic regurgitation vena contracta width as follows: group B, < 3 mm, mild ( n = 16); group C, ≥ 3 and < 6 mm, moderate ( n = 26); group D, ≥ 6 mm, severe ( n = 18). BNP measurements were performed with a fluorescence immunoassay kit. BNP levels were increased in patients with aortic regurgitation, and severity of regurgitation had a significant influence on BNP levels. This effect can be explained by the volume loading effect of aortic regurgitation.

The prevalence and course of pulmonary hypertension and right ventricular dysfunction in patients undergoing orthotopic heart transplantation

BACKGROUND

Pulmonary hypertension (PHT) and right ventricular (RV) dysfunction are among the commonly observed and potentially serious complications following heart transplantation. RV dysfunction is reported to occur in as much as half of these patients. In this study, the authors sought to examine the prevalence and the course of these prognostically important complications.

METHODS

The records of 30 patients who had undergone orthotopic heart transplantation at our center were examined. Demographic and clinical variables were noted; RV dysfunction, pulmonary artery pressure on Doppler echocardiographic examination, and catheter findings were recorded.

RESULTS

The mean age of the study population was 31.3 years. On preoperative assessment, PHT was present in 21 (70%) patients. The average value of systolic pulmonary artery pressure was 44.5 ± 5.9 mm Hg. The mean value of pulmonary vascular resistance was 3.3 ± 1.8 hybrid reference unit (HRU). RV dysfunction was detected on postoperative assessment in 17 (56.7%) patients. The mean ischemia time was 216 ± 77 minutes; in 3 cases it exceeded 5 hours but in none of the cases did it reach 6 hours. Rejection was detected in 14 (46.7%) patients. Most of the patients received inotropic agents in the early postoperative period. When compared with preoperative values, on follow up at the end of the first year, a significant decrease in pulmonary artery pressure was observed (47.4 ± 4.8 vs 38.5 ± 7.5 mm Hg; P = .03), and the ratio of patients experiencing RV dysfunction decreased to 16.6% (n = 5).

CONCLUSION

The findings of this study indicate that RV dysfunction and PHT are common complications following heart transplantation and improve with appropriate management over time with monitoring.

Tumour necrosis factor-alpha, interleukin-10, interferon-gamma and vitamin D receptor gene polymorphisms in patients with chronic hepatitis delta

No data exist to assess certain polymorphisms that have a potential effect on the immune response in patients with chronic hepatitis delta (CHD). The aim of this study was to investigate polymorphisms in 6 polymorphic sites: IL-10 -1082 (rs1800896), IL-10 -627 (rs1800872), IFN-γ +874 (rs62559044), TNF-α -308 (rs1800629), vitamin D receptor (VDR) FokI (rs2228570) and VDR TaqI (rs731236). The genotypes of 67 patients with CHD and 119 patients with chronic hepatitis B (CHB) were compared. In addition, 56 individuals with resolved hepatitis B virus (HBV) infection were used as a control group for patients with CHB. Polymorphisms in TNF-α, IL-10, and VDR genes were analysed using polymerase chain reaction/restriction fragment length polymorphism methods. The IFN-γ gene polymorphism was detected by allele-specific polymerase chain reaction (PCR). Patients with CDH were more likely to have advanced liver disease compared with patients with CHB (P < 0.0001). IL-10 -1082 and VDR TaqI polymorphisms showed significant differences between patients with CHD and CHB. The high secretory IL-10 -1082 genotype GG was less frequent in CHD compared with patients with CHB and resolved HBV (17.7%, 37.4% and 47.1%, respectively (P < 0.05 for CHD vs CHB and resolved HBV). The frequency of the high secretory VDR TaqI TT genotype was 86.6% in patients with CHD, 62.7% in patients with CHB and 62.5% in resolved HBV individuals (CHD vs CHB: P < 0.05). None of the polymorphisms analysed had an effect on HBV persistence. IL-10 -1082 and VDR TaqI polymorphisms may contribute to the more severe liver disease associated with CHD compared with CHB.

A rare subtelomeric deletion syndrome: Wolf Hirschhorn syndrome

Wolf-Hirschhorn syndrome is caused by a deletion of the distal portion of the short arm of chromosome 4, and is characterized by psychomotor retardation, seizures, congenital malformations, and typical facial appearance including 'Greek warrior helmet' appearance of the nose. The form and the severity of clinical manifestations vary according to the size and location of the deletion. Major complications are severe growth retardation, developmental delay, seizures, feeding difficulties due to hypotonia, and predisposition to respiratory infections. Patients will benefit from supportive therapy and special education. It is important in terms of prognosis to provide counseling to families in this respect. We present here a case with Wolf-Hirschhorn Syndrome in order to remind its rarity and the ability of the patients' progress in the areas of motor skills, speech, social interaction.

Folic acid modified clay/polymer nanocomposites for selective cell adhesion

A promising material, a folic acid modified poly(epsilon-caprolactone)/clay nanocomposite that allows selective cell adhesion and proliferation, was synthesized and characterized as a cell culture and biosensing platform.

The effect of small-molecular-weight heparin added to chemotherapy on survival in small-cell lung cancer - A retrospective analysis

Aims and Background: Small cell lung cancer (SCLC) is a chemotherapy-responsive tumor and associated with alterations in the coagulation system. Addition of low-molecular-weight heparin (LMWH) to combination chemotherapy (CT) had resulted in increase in survival. The present retrospective trial was designed to determine whether the duration of dalteparin usage has an effect on progression and survival. Materials and Methods: The medical records of 67 patients with SCLC who were given cisplatin-etoposide and concomitant LMWH (dalteparin) was evaluated retrospectively. Results: Median follow-up of patients was 11.3 months. Outcome: 10.6% complete response, 3.0% good partial response, 36.4% partial response, 10.6% stable disease, and 39.4% progressive disease. Side-effects were seen in 40.3% of the patients. Median dalteparin duration was 6,1 months. According the duration of dalteparin patients were grouped in three: who took dalteparin less than 4 months (Group A), 4-6 months (Group B) and more than 6 months (Group C). Mean overall survival (OS) in Group A was 6.5 months, in Group B 11.8 months, and Group C 14.6 months. Mean OS in Group B and C were statistically significantly (P < 0.001) longer than Group A, between Group B and C there was not any significant difference (P = 0.037). Mean progression free survival (PFS) was 9 months. Conclusions: The CT plus LMWH minimum 4 months long is well-tolerable, and may improve PFS and OS in patients with SCLC. For treatment of patients with SCLC CT plus LMWH may be considered as effective future-therapy, and further multi-centre randomised prospective clinical trials must be done to determine the new standard treatment approach for SCLC.

Concomitant infection of the tricuspid valve and right ventricle free wall after chest tube insertion in a young patient without predisposing diseases

Infective endocarditis (IE) is one of the most dreaded complications of healthcare-associated bloodstream infection. It is an important and potentially lethal complication of medical care and there is incidence evidence of it in this population. We describe a case of concomitant infection of the tricuspid valve and right ventricle free wall after chest tube insertion for spontaneous pneumothorax in a young patient without predisposing diseases.

Isolation of hydroxytyrosol from olive leaves extract, radioiodination and investigation of bioaffinity using in vivo/in vitro methods

It is known that medicinal plants like olive have biological activities due to their flavonoid content such as olueropein, tyrosol, hydroxytyrosol etc. In current study, hydroxytrosol (HT) which is one of the major phenolic compounds in olive, olive leaves and olive oil, was isolated after methanol extraction and purification of olive leaves which are grown in the northern Anatolia region of Turkey. The isolated HT was radiolabeled with 131I (131I-HT) and the bioaffinity of this radiolabeled component of olive leaves extract was investigated by using in vivo/in vitro methods. It was found that HT could be radiolabeled with 131I in yields of 95.6±4.4% (n = 8), and in vivo studies showed that 131I-HT is taken up by urinary bladder, stomach, small intestine, large intestine, breast and prostate. Significant incorporation of activity was observed in cell lines via in vitro studies.

Three-dimensional transesophageal echocardiographic evaluation of cor triatriatum in adults

We present the cases of two adult patients with cor triatriatum due to left atrial membrane with atrioventricular septal defect and right atrial membrane. Two-dimensional and real-time three-dimensional transthoracic echocardiography were performed. These noninvasive modalities provided a comprehensive anatomic and hemodynamic evaluation of the anomaly.

Relationship between endothelial dysfunction and prosthetic heart valve thrombosis: a preliminary investigation

AIM

The etiopathogenesis of prosthetic heart valve thrombosis (PHVT) is multifactorial. Since the relationship between PHVT and endothelial function is never studied, we aimed to analyze the role of endothelial function in patients with PHVT.

PATIENTS AND METHODS

Twenty-two patients with PHVT (14 female, 31.8% with atrial fibrillation, mean age 46.0±12.2) and 22 controls with prosthetic heart valves (17 female, 36.4% with atrial fibrillation, mean age 45.7±11.5) were prospectively evaluated. Two groups had similar demographic and echocardiographic characteristics. Endothelial function was evaluated in all patients by the non-invasive measurement of flow mediated dilatation (FMD) of brachial artery. High-resolution ultrasound was used to measure brachial artery diameter at rest, during reactive hyperemia (endothelium-dependent, FMD), and following sublingual administration of nitroglycerin (endothelium-independent, nitroglycerin-mediated vasodilatation, NMD).

RESULTS

Functional capacity at presentation determined as mean NYHA functional capacity class was worse in patients with PHVT than in control group (2.1±0.6 vs. 1.3±0.6; p < 0.0001). FMD was significantly reduced in patients with PHVT compared with control group (4.01±1.52 vs. 8.48±3.37; p < 0.0001). NMD did not differ between two groups (11.77±2.30 vs. 13.38±3.50; p = 0.08). FMD level of < 5.65 predicted prosthetic valve thrombosis with an 82% sensitivity and 77% specificity (area under the curve = 0.888, p < 0.0001).

CONCLUSIONS

This study demonstrated the endothelial dysfunction in patients with PHVT compared with well-matched control group. In this study, we found that patients with PHVT have endothelial dysfunction which might contribute to the development of thrombosis.

D-dimer is a marker of response to chemotherapy in patients with metastatic colorectal cancer

PURPOSE

D-dimer, LDH and tumor markers are usually overexpressed in colorectal carcinomas (CRC). Our purpose was to assess the prognostic role of D-dimer, lactate dehydrogenase (LDH), CEA, CA19-9 and CA72-4 in patients with metastatic CRC treated with XELOX chemotherapy.

METHODS

Thirty-eight CRC patients who had evidence of distant metastasis were enrolled in the study and blood samples were taken before chemotherapy for estimation of the tumor markers CEA, CA19-9 and CA72-4, and for D-dimer and LDH. Patients were randomized into 3 groups: those with partial response (PR), stable disease (SD), and progressive disease (PD) according to their clinical and radiologic evaluation after 3 cycles of XELOX chemotherapy. All parameters were reevaluated after the 3rd cycle of chemotherapy.

RESULTS

Eighteen patients (47.3%) achieved PR, 10 (26.3%) SD, and 10 (26.3%) showed PD. After 3 cycles of XELOX CEA (20.55 vs 11.97 ng7sol;ml; p=0.002), LDH (357.50 vs 214.0 U7sol; lt; p=0.001) and D-dimer (1.56 vs 1.17 μgFEU/ml; p=0.022) levels were significantly decreased in the PR group. D-dimer levels were also notably decreased (1.36 vs 0.77 μgFEU/ml; p=0.021) in the SD group. In the PD group a considerable increase was seen in CA 19-9 (119.5 vs 243.09 U/ml; p=0.025), CA 72-4 (5.18 vs 25.8 U/ml; p=0.036) and D-dimer levels (1.77 vs 1.88 μgFEU/ml; p=0.012).

CONCLUSION

This study demonstrated that D-dimer, LDH and tumor markers can be helpful in determining CRC prognosis in patients with metastatic disease. D-dimer, LDH and tumor markers provided unique prognostic information in advanced CRC patients.

The effect of being overweight on survival in patients with gastric cancer undergoing adjuvant chemoradiotherapy

The aim of this study was to examine the effect of being overweight on survival in patients with gastric cancer undergoing adjuvant chemoradiotherapy and chemotherapy. In this study 152 patients were evaluated. Radiotherapy dose was 45 Gy given in 5 weeks. 5-FU 425 mg/m(2) and folinic acid 20 mg/m(2) were administered weekly during the radiotherapy and four cycles with 4-week intervals as consolidation chemotherapy after radiotherapy. Patients were assigned into two groups according to their body mass index: overweight (body mass index ≥25 kg/m(2)) and normal weight (body mass index <25.0 kg/m(2)). The median overall survival was 39 months vs. 18 months and median disease-free survival was 27 months vs. 13 months in the overweight and normal-weight groups respectively (P = 0.004 and P = 0.006 respectively). The 5-year survival was better in the patients with overweight than those with normal weight (42% vs. 17%; P = 0.004). The overall survival was significantly better with being overweight and early pathological stage (P = 0.016 and P = 0001 respectively). Overall survival, disease-free survival and long-term survival in patients with gastric cancer undergoing adjuvant treatment were better in overweight than normal-weight patients. Moreover, it was shown that body mass index and pathological stage were associated to survival and prognosis.

Gemcitabine and cisplatin combination chemotherapy in triple negative metastatic breast cancer previously treated with a taxane/anthracycline chemotherapy; multicenter experience

This study was aimed to establish clinical efficacy and tolerability of gemcitabine and cisplatin combination in patients with metastatic triple negative breast cancer progressing after anthracycline and taxane based chemotherapies.Thirty-three patients who were given cisplatin and gemcitabine for triple negative and metastatic breast cancer were evaluated retrospectively. A total of 141 cycles were administered with a median 4 cycles per patient. Median follow-up time was 14 months (range, 2-36 months). Objective response rate was 27.3%. Total clinical benefit of the combination was 48.4%. The estimated median progression free survival and median overall survival were 5 months and 14 months, respectively. The most common Grade 3 and 4 toxicity were neutropenia and thrombocytopenia observed in 10 (27.7%) and 9 (24.9%) patients, respectively. The combination of the gemcitabine and cisplatin after taxane/anthracycline is well tolerated and seems to be effective with acceptable toxicity profile.

Prognostic factors in patients with advanced pancreatic cancer treated with gemcitabine alone or gemcitabine plus cisplatin: retrospective analysis of a multicenter study

PURPOSE

The majority of patients with pancreatic cancer present with advanced disease. Systemic chemotherapy for patients with pancreatic cancer has limited impact on overall survival (OS). Patients eligible for chemotherapy should be selected carefully. The aim of this study was to analyse prognostic factors for OS in advanced pancreatic cancer patients treated with first-line palliative chemotherapy with gemcitabine alone or gemcitabine plus cisplatin.

METHODS

We retrospectively reviewed 343 locally advanced or metastatic pancreatic cancer patients who were treated with gemcitabine or gemcitabine plus cisplatin as first-line chemotherapy between December 2000 and June 2011. Fifteen potential prognostic variables were chosen for analysis. Univariate and multivariate analyses were conducted to identify prognostic factors associated with OS. Univariate and multivariate statistical methods were used to determine prognostic factors.

RESULTS

Among the 15 variables of univariate analysis, 6 were identified to have prognostic significance: stage (p<0.001), cholestasis (p=0.02), weight loss, prior pancreatectomy, serum CEA level (p<0.001) and serum CA19-9 level (p>0.001). In addition, age, chemotherapy and liver metastasis were of borderline significance (p=0.06). Multivariate analysis (Cox proportional hazard model) included the 6 significant prognostic factors of univariate analysis and showed that stage was independent prognostic factor for OS, as were weight loss, and serum CEA level.

CONCLUSION

Stage, weight loss, and serum CEA level were identified as important prognostic factors for OS in advanced pancreatic cancer patients. These findings may also facilitate pretreatment prediction of OS and can be used for selecting patients for treatment.

The access rate to diagnosis and treatment modalities in breast cancer patients in Turkey; multicenter observational study

PURPOSE

To determine the time elapsed between the first notification of the disease and the access to the diagnosis and treatment modalities and the associated factors in female patients with breast cancer in Turkey.

METHODS

Data was acquired from a questionnaire involving 535 patients who applied to 14 various oncology clinics in Turkey between 1st and 28th of February 2010. Analyses were performed by the participating clinics and were divided into 3 groups: centers located in metropolitan areas formed group 1 (n=161), those located in Marmara and central Anatolia region formed group 2 (n=189), and centers located in Karadeniz and East-Southeast Anatolia region formed group 3 (n=185). The groups of these centers were formed according to the socioeconomic development of the provinces.

RESULTS

The median patient age was 48 years, 56.1% of patients were less than 50 years of age. Eighty-five percent of the patients detected a mass in their breast by self examination and 27% of the patients older than 50 years never had breast imaging until the definite diagnosis was established. The median time elapsed between disease noticed by the patient and application to a health care center was 10 days, between application and biopsy 19 days, between biopsy and surgery 10 days, and between surgery and systemic therapy 31 days. The median time elapsed between patients applying for surgery in groups 1 and 2 centers was 11 and 21 days, respectively (p=0.01). The median time elapsed between biopsy and surgery in groups 1,2 and 3 centers was 14,1.5, and 12 days, respectively (p<0.05).

CONCLUSION

A high level of awareness regarding breast cancer in our country is related with the time that is defined as 10 days between disease recognition and medical application. The time elapsed between the application and biopsy, surgery and systemic therapy was longer compared with the corresponding figures in developed countries.

Electronic microarrays in DNA computing

DNA Computing is a rapidly-developing interdisciplinary area which could benefit from more experimental results to solve practical problems with the current biological tools. In this study, we have integrated microelectronics and molecular biology techniques for the storage of information and basic arithmetic operations via DNA. Using 16 different complementary sequences of DNA, we stored 4 bits of information on an electronic microarray and read the data via the fluorescent signal strength coming from the microarray pads. We also showed the possibility of addition and subtraction of quantities of fluorescently tagged DNA determined via their fluorescent signal strength. We conclude that the hybrid technology we employed, based on a matured Si-CMOS platform, has the potential to strengthen the pursuit of DNA Computation as well as finding its own niche applications.

Data transmission performance of few layer graphene ribbon interconnects

We present the digital data transmission performance of few-layer graphene ribbon interconnects grown by chemical vapor deposition which are potential candidates for interconnect applications, and serve as a replacement for problematic metal interconnects at small length scales and overcome their limitations in data transmission performance. Graphene ribbon interconnects having a mobility of 2,180 cm2V(-1) s(-1) can sustain data rates up to 90 megabits per second at 100 nm length. These interconnects behave as RLC lines, thus the bandwidth is inversely proportional to resistance caused by defects in the graphene layers and the inductance and capacitance of the interconnect lines. Improving the graphene mobility to highest measured values (approximately 200,000 cm2V(-1) s(-1)) and using structures with multiple coplanar transmission lines in parallel could carry the bandwidth beyond the terabits per second level.

Electronic microarrays in DNA computing

DNA Computing is a rapidly-developing interdisciplinary area which could benefit from more experimental results to solve practical problems with the current biological tools. In this study, we have integrated microelectronics and molecular biology techniques for the storage of information and basic arithmetic operations via DNA. Using 16 different complementary sequences of DNA, we stored 4 bits of information on an electronic microarray and read the data via the fluorescent signal strength coming from the microarray pads. We also showed the possibility of addition and subtraction of quantities of fluorescently tagged DNA determined via their fluorescent signal strength. We conclude that the hybrid technology we employed, based on a matured Si-CMOS platform, has the potential to strengthen the pursuit of DNA computation as well as finding its own niche applications.