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Deep eutectic solvent extraction for As, Mn, Pb, Cr, and Ni from spleen, kidney, and brain samples was investigated. The experimental parameters such as type and amount of deep eutectic solvent and sample/deep eutectic solvent ratio were optimized. The method optimization was conducted with the certified reference material (BCR 185-R). The analytical characteristics such as limits of detection and quantitation, relative standard deviation, and calibration equations were determined. Different deep eutectic solvent types were prepared and examined for better extraction. Choline chloride was used as a quaternary ammonium salt, and oxalic acid, urea, thiourea, and citric acid were used as hydrogen bond donors. Better results and recoveries higher than 90% were obtained with oxalic acid. The calculated LOD values for As, Mn, Pb, Cr, and Ni were 1.1, 0.3, 1.3, 1.4, 0.8, and LOQ values were 3.8, 1.1, 4.3, 4.7, 2.7 mg/kg, respectively.

With the start of Industry 4.0 in 2011, new concepts and technologies have entered the IT literature. Some of these technologies are virtualization, modularity, big data and deduplication. Big data can be defined as data of a magnitude that exceeds the ability of traditional database systems to collect, store, manage and analyze data. Today, data is diverse, large and rapidly changing. This situation cannot be solved with the traditional database structure. With the emergence of big data, it has become difficult to process data with the algorithms used for data processing. Therefore, new algorithms and technologies have been developed. The most important of these technologies is data deduplication. Deduplication backs up data by dividing it into variable or fixed sizes. In this way, it aims to save storage space by storing only one copy of many repeated data. Today, "deduplication and compression" is an indispensable feature for data storage in both server-storge and hyper-converged architecture systems. Recently, artificial intelligence technologies are advancing very rapidly and their application areas are expanding. Therefore, Artificial Intelligence is a technology that will be very important for the industry and our lives in the future. The purpose of this paper is to give an idea about the relationship between deduplication technology and artificial intelligence by examining various deduplication systems and algorithms. Studies in the literature show that deduplication provides significant savings in storage space, the importance of data security, and the use of artificial intelligence and deduplication as a whole.

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Pollution with aromatic hydrocarbon has been rising because of the extreme usage of benzene containing compounds. Most of the people, animals and plants have been exposed to aromatic hydrocarbons due to polluted water sources. The aim of the present work was to carry out an experimental study for the photocatalytic degradation of aromatic hydrocarbon containing compounds by iron-titanium-pillared interlayered clays (Fe-Ti-PILCs) and copper-titanium-pillared interlayered clays (Cu-Ti-PILCs). For this purpose, a dye named disperse blue 56 (DB56) was selected for treatment experiment. Zeolite was used as a catalyst support material to prepare Fe-Ti-PILCs and Cu-Ti-PILCs. The experiments were carried out in batch method and UV-Vis spectroscopy was used for analysis. Several parameters such as contact time, H2O2 and amount of PILCs were examined to find optimized conditions. The obtained degradation rates using Cu-Ti-PILCs were better than Fe-Ti-PILCs. The obtained highest removal rates were ~97% and ~94% for Cu-Ti-PILCs and Fe-Ti-PILCs, respectively in 120 min reaction time with using 100 mg/L of dye, 1 g of Fe-Ti-PILC and Cu-Ti-PILCs and 1 mL of H2O2.

Objective: Despite the existence of detailed consensus guidelines, challenges remain regarding the role angiogenetic factors on non-small cell lung cancer (NSCLC). This study was conducted to determine the role of the vascular endothelial growth factor (VEGF), interleukin-8 (IL-8) and angiopoietin2 (Ang2) in patients with NSCLC. Methods: This study included 64 consecutive patients with non-small cell lung cancer, who admitted to clinic. Pre-treatment serum VEGF, IL-8 and Ang2 levels were evaluated. Patients were treated according to internationally accepted guidelines. Results: VEGF and IL-8 serum levels of patients with both squamous cell carcinoma and adenocarcinoma were significantly higher than controls (p

Aim: The aim of this study was to determine the clinicopathological characteristics, treatment details and outcome of patients with brain metastasis from epithelial ovarian carcinoma (EOC). Methods: This study included 21 patients diagnosed with brain metastasis from EOC between 1999 and 2009. Results: Median age was 61 years (range 38-77). The median time elapsed from EOC diagnosis to brain metastasis detection was 32 months. Single brain metastases were found in 10 (48%) cases, and there was extra-cranial disease in 11 (52%) cases. During the mean 86 months of follow-up, 18 of the patients (86%) died of the disease and 3 (14%) were alive with disease. The median survival time after the initial diagnosis of brain metastasis was 9 months. The median overall survival (OS) from initial diagnosis of EOC was 50 months. In univariate analysis, prolonged time from initial diagnosis to central nervous system metastasis (more than 32 months) (p = 0.001), treatment with radiotherapy (p < 0.001), optimal cytoreductive operation (p = 0.02) were all positively correlated with OS. Conclusion: The prognosis of patients with brain metastasis from EOC is still poor. The significant predictors of survival in our series were whole brain radiotherapy, prolonged elapsed time from initial diagnosis to brain metastasis and optimal cytoreductive surgery.

In this manuscript, we report the development of a rapid and facile optic sensor for highly sensitive and selective detection of cobalt ions (Co(II)). The detection strategy was based on the specific silver nanoparticle-glutathione interaction and later on secondary interaction of this structure with cysteine and Co(II) ion. The interaction of these structures creates a new absorption band in the UV region. The intensity change of this band can be correlated by Co(II) ion concentration. The addition of cysteine decreases the Surface Plasmon Resonance (SPR) of silver nanoparticles but does not provide quantitative information. The proposed method offers the advantage of improved sensitivity for detection of Co(II) ions in a very short time period. Co(II) ions create a unique absorption peak during the complex formation and this peak provides sensitive determination of this metal ion in existence of other metal ions. The peak is visible only after taking the first derivative of absorption spectra. Under the optimized conditions, the detection limit of the method is around 0.68 μM. In addition, the synthesized silver nanoparticles (AgNPs) were characterized by atomic force microscopy (AFM). The proposed metal ion sensor provides a very facile and convenient way to determine the concentration of Co(II) ions in aqueous system.

Muhasebe meslek etiği kuralları, mesleki uygulamalarıstandartlaştırmak ve mesleğin itibarını korumak amacıyla geliştirilmiştir. Etikkurallar, muhasebenin sosyal sorumluluğunun yerine getirilmesinde önemli birunsurdur. Çalışmanın amacı,muhasebe meslek mensuplarının, mesleketiği uygulamalarına bakış açılarının tespit etmektir. Çalışmada, muhasebemeslek etiği kavramsal olarak ele alınmış, meslek etiğinin önemi vurgulandıktansonra, meslek etik kurallarının gelişim süreçleri açıklanmıştır. Amaç doğrultusunda BatıAkdeniz Bölgesinde faaliyet gösteren, meslek mensuplarına yönelik ankete dayalıbir araştırma yapılmıştır. Elde edilen veriler, istatistikî metotlarla testedilmiş, muhasebe meslek mensuplarının muhasebe meslek etiği uygulamalarınabakış açıları ile ilgili sonuçlar değerlendirilmiştir., The Accounting professional ethics guidelines have been developed to standardize professional practices and toprotect the reputation of the profession. Ethical rules are an important element in fulfilling the socialresponsibility of the accountant. The aim of study is to determine the perspectives of professional accountants onthe practice of professional ethics. In the study, accounting profession ethics was conceptually considered andafter the emphasis of profession ethics was emphasized, the process of development of professional ethics ruleswas explained. To reach this goal, a survey-base study has been done on profession members working in thewest Mediterranean Region. The data has been tested with various statistical methods and the results of attitudeson occupational ethics of professionals have been evaluated.

Neoadjuvant therapy refers to the systemic treatment of breast cancer prior to definitive surgical therapy. Neoadjuvant therapy is administered with the objective of improving surgical outcomes in patients with breast cancer for whom a primary surgical approach is technically not feasible and for patients with operable breast cancer who desire breast conservation but for whom either a mastectomy is required or a partial mastectomy would result in a poor cosmetic outcome. In addition, neoadjuvant chemotherapy is appropriate for patients with HER2-positive or triple-negative breast cancer who are most likely to have a good locoregional response to treatment, regardless of the size of their breast cancer at presentation.

Carboplatin-paclitaxel chemotherapy combination is the standard first-line treatment of advanced ovarian cancer and is the most commonly used treatment combination shown to be effective in advanced non-small-cell lung cancer (NSCLC). The most important dose-limiting side effect is hematologic toxicity. In this study, the severity of treatment-related myelotoxicity is compared in patients with advanced ovarian and lung cancers who received same schedule of carboplatin-paclitaxel. The study was prospectively performed from February 2009 to July 2011 and involved 103 patients with stages Ic-IV ovarian (n = 51) and advanced NSCLC (n = 52) who were administered a maximum of 6 cycles of carboplatin-paclitaxel as a first-line treatment. Full blood counts were measured before treatment, before each chemotherapy cycle during therapy, and at the first and sixth month after therapy. The median ages were 59 years (range, 35-77 years) for patients with NSCLC and 56 years (range, 38-75 years) for patients with ovarian cancer. The frequencies of anemia were 17% and 28.6% before the initiation of chemotherapy, 39.2% and 68.0% at the third cycle of treatment, and 44.2% and 45.2% at the sixth cycle of treatment in patients with NSCLC and ovarian cancer, respectively. Initial leukopenia rates were 3.4% and 0%; at the third cycle 46.0% and 41.2%; and at the sixth cycle 41.9% and 48.8% in patients with NSCLC and ovarian cancer, respectively. At the third cycle, 2.5% of the patients with NSCLC and 10.4% of the patients with ovarian cancer had thrombocytopenia, and at the sixth cycle, 23.3% of the patients with NSCLC and 25% of the patients with ovarian cancer had thrombocytopenia. Hemoglobin, leukocyte, and platelet values at the third cycle were significantly lower than those at admission in both cancer groups. Declines in hemoglobin levels in patients with NSCLC and in platelets in patients with ovarian cancer at the sixth cycle were statistically significant compared with the third cycle. In conclusion, the same schedule of chemotherapy may lead to different myelotoxicities in different types of cancer. These results should be taken into consideration in terms of supportive care and management of toxicity.

Background The protease-activated receptor 1 (PAR1) is associated with increased invasiveness of breast cancer (BC) cell lines and its overexpression is significantly correlated with advanced stage and poor prognosis. The aim of this study was to determine the clinical significance of the serum PAR1 levels in BC patients. Methods We enrolled 96 female patients with pathologically diagnosed BC who did not receive chemotherapy (CT) or radiotherapy. Serum PAR1 levels were measured by ELISA method and compared with 30 healthy controls. Results The mean serum PAR1 level of BC patients was significantly higher than controls (3.07 vs 2.82 ng/ml, p = 0.011). The levels of PAR1 tended to be higher among CT responders ( p = 0.052) and grade I disease than others ( p = 0.055). However, there was no significant difference in PAR1 levels according to other clinic-pathological or laboratory parameters. Serum PAR1 level did not have a significant impact on overall survival in both univariate ( p = 0.73) and multivariate analysis ( p = 0.67). Conclusion Serum PAR1 level is elevated in BC patients and may have predictive role for CT response. However, it has no prognostic role on survival.

Disseminated intravascular coagulation (DIC) is a fatal presentation of metastatic adenocarcinoma of the prostate. A 59-year old male presented with a 2-week history of fatigue, red urine, and bruises on his body. Physical examination and ultrasonography showed that the patient had an enlarged prostate. Laboratory analysis was consistent with DIC. The patient's PSA level was 90 ng mL−1. Bone scintigraphy showed diffuse metastasis. Histopathological analysis of a biopsy specimen showed prostate adenocarcinoma. Acute DIC improved rapidly following initiation of leuprolide and bicalutamide hormone therapy. The patient's PSA dropped from 90 to 0.01 ng mL−1 after 1 month of treatment. The patient had recurrence of the initial complaints and elevated PSA while receiving leuprolide treatment in first year. As the patient's clinical condition deteriorated, we initiated docetaxel-containing chemotherapy. The patient's symptoms became less severe and his abnormal laboratory findings began to normalize after 2 weeks of the chemotherapy, and they completely resolved returned to normal after 2 months. In conclusion, docetaxel-containing chemotherapy in a patient with metastatic prostatic carcinoma and DIC was effective, despite a low platelet count and bleeding.

e13055 Background: The combination of ribociclib with ET significantly increased progression free survival (PFS) and OS compared with ET in first line treatment of HR positive HER2 negative MBC. We aimed to evaluate the efficacy and safety of ribociclib and letrozole within Turkish MAP in order to present clinical outcome with the real-world use of ribociclib, outside of clinical trial setting. Methods: Turkish MAP enabled access to ribociclib in combination with letrozole as first-line therapy for MBC patients with HR positive and Her-2 negative tumors. Adequate bone marrow reserve, a normal QTc interval, normal renal and liver functions were required for eligibility. Patients received 600 mg ribociclib once daily for 3 wks followed by 1wk off. A retrospective chart review of patient demographics, clinical and treatment characteristics have been performed. Results: Between July and November 2017, 178 patients were included from 47 institutions in Turkey. We report the results of first 101 patients analyzed. The median age was 53 years (33–81 years) and median follow up was 16 months. Forty-six patients had de novo disease, 78% patients were postmenopausal, 22% had ovarian function suppression. Thirty-six % patients had adjuvant chemotherapy, 49% received adjuvant ET. Forty % had visceral disease. Thirty patients had grade 3 neutropenia, 3 patients had febrile neutropenia, 5 patients have grade 2-3 elevation of liver function tests. There was no QT prolongation. Dose reduction to 400 mg was required for 16 patients. Four patients discontinued ribociclib due to toxicity, 22 patients due to progression, one patient refused treatment. Twelve patients had complete remission as their best response. Median PFS was 24.12 months (95%CI 22.2-26.2). None of the clinical and pathologic factors were significantly associated with prolonged PFS. Conclusions: The efficacy and toxicity of first-line ribociclib and letrozole within Turkish MAP is similar to the results from randomized clinical studies for patients with HR positive, Her-2 negative MBC.

Preoperative systemic therapy is a commonly used therapeutic approach to treat locally advanced and operable, primarily non-operable, or inflammatory breast cancer. Preoperative systemic therapy should be an option for patients who would require adjuvant systemic therapy. Neoadjuvant therapy is most appropriate for patients likely to have a good locoregional response, regardless of tumor size at presentation, including those with HER2-positive or triple-negative breast cancers. The decision regarding neoadjuvant treatment should be made after a discussion of the patient’s clinical, histological, and imaging characteristics by a multidisciplinary oncology board that includes surgical oncologists, medical oncologists, radiation oncologists, radiologists, and pathologists.

Desmoid tumors (DTs) are benign tumors that exhibit fibroblastic proliferation, which arises from fascial or musculoaponeurotic structures. The aim of this study was to investigate the characteristics and outcomes of patients with resectable DTs. A total of 21 patients were included and their clinicopathological characteristics were retrospectively analyzed. The 21 patients (16 females and 5 males) were identified through reviewing the patient charts at our institute. The tumor was located in the lower extremities in 7 cases, in the upper extremities in 4 cases, in the abdominal region in 9 cases and in the neck region in 1 case. Patients who had been initially treated by surgical excision were included in the study. Of these 21 patients, a positive surgical margin (SM) was reported in 11 patients, 7 of whom received postoperative radiotherapy (RT). Ten patients had a negative SM and 6 received RT. A total of 5 patients (46%) in the positive SM group and 4 (40%) in the negative SM group had documented disease relapse (P>0.05). The median relapse-free survival (RFS) was 20.5 months for the patients treated by surgery alone and 50 months for those treated with surgery followed by adjuvant RT (P>0.05). Age, gender, SM and adjuvant RT were not identified as predictors of recurrence. No predictive factors appeared to indicate local DT recurrence following surgery.

Aims and background To investigate the efficacy and tolerability of biweekly scheduled triplet chemotherapy consisting of gemcitabine, cisplatin and vinorelbine for chemotherapy-naïve advanced non-small cell lung cancer. Methods and study design Patients with stage IIIB/IV non-small cell lung cancer and performance status of 0–2 were eligible. Patients who had brain metastasis and of an older age were also enrolled in the study. The triplet combination chemotherapy consisted of gemcitabine, cisplatin and vinorelbine at the doses of 1000 mg/m2, 25 mg/m2 and 50 mg/m2, respectively, were administered on day 1 and 14, every 28 days, up to 6 cycles. Results Thirty patients were enrolled in the study. Median age was 60 years (range, 42–74). Most of the patients (83%) had metastatic disease and 7 patients (23%) had brain metastasis. In assessing 24 patients for response evaluation, none had complete response. Partial responses were achieved in 18 (60%) patients. Four patients (13%) had stable disease and 2 (7%) progressed. Thirteen percent and 20% of the patients developed severe (grade 3–4) neutropenia and anemia, respectively. Febrile neutropenia, severe thrombocytopenia, hepatic and renal toxicity were not seen. Overall and progression-free survival were 8.15 and 7.15 months, respectively. Patients who had no brain metastasis (P = 0.069), who had more than 3 courses of chemotherapy (P Conclusions The biweekly schedule of the triplet chemotherapy combination including gemcitabine, cisplatin and vinorelbine was effective in advanced, mostly metastatic non-small cell lung cancer with acceptable and manageable side effects.

The availability of Cd, Co, Cr, Cu, Mn, Ni, Pb, Fe and Zn of dust from vehicle air and pollen filters were investigated by four-step BCR (European Community Bureau of Reference) sequential extraction procedure. The acid-soluble, reducible, oxidizable, residual extracts were measured by inductively coupled plasma-optical emission spectrometry (ICP-OES). The results indicated that both of air and pollen filter dusts contained higher concentration of Fe. To estimate the accuracy of the method the standard reference material BCR 701 was used. The results for recovery all the elements were found in the range 95.4-101.3%. The mean concentrations [μg/g] of trace elements in dusts from air filters/pollen filters were: cadmium 16.72/17.56; cobalt 24.22/23.72; chromium 46.02/55.44; copper 44.92/37.67; iron 1868.03/1854.92; manganese 231.2/213.64; nickel 38.89/45.27; lead 60.99/67.17; zinc 199.58/201.25. The results obtained are in agreement with data reported in the literature.

Pancreatic cancer is a major health concern worldwide and, despite the attempts at management, the prognosis of patients with metastatic pancreatic cancer remains poor, with a median survival of a few months. The aim of this study was to identify and evaluate clinicopathological factors and elucidate the clinical significance of patient age for the outcome of metastatic pancreatic cancer. Data from a total of 154 metastatic patients with a histologically confirmed diagnosis of pancreatic cancer, who were treated and followed-up in our clinic, were recorded from medical charts. The patient sample included 102 (66%) males with a median age of 58 years (range, 25–88 years). The majority of the patients had a poor performance status (64%), weight loss of >10% body weight (74%), tumor size of >3 cm (75%) and elevated tumor markers, including carcinoembryonic antigen (CEA) (66%) and carbohydrate antigen 19-9 (CA19-9) (85%). The distributions of prognostic factors depending on patient age were largely identical. The median survival time of patients with metastatic disease was 179 days and the 1-year survival rate was 7%. The median survival time of elderly patients was significantly lower compared to younger patients (148 vs. 198 days, respectively; P=0.039). The 1-year survival rates in elderly and younger patients were 3 and 10%, respectively. In the univariate and multivariate analyses, elderly patients had poorer outcomes compared with younger patients (P=0.04 and 0.05, respectively). In all patients, the univariate analysis demonstrated that similar prognostic factors, including the performance status of the patients and tumor markers, such as serum CEA and CA19-9 levels, were associated with survival. In the multivariate analysis, younger patients with a poor performance status had a significantly shorter overall survival compared to those with a good performance status (P=0.008). However, no significant prognostic factor affecting the outcome was identified in the elderly patients. In conclusion, patient age is a major prognostic factor affecting the survival of patients with metastatic pancreatic cancer and elderly patients without poor prognostic factors may be eligible for the available treatment options.

SummaryActivation of coagulation and fibrinolysis is frequently encountered among cancer patients. Such tumors are supposed to be associated with higher risk of invasion, metastases and eventually worse outcome. The aim of this study is to explore the prognostic value of blood coagulation tests for lung cancer patients. The study comprised 110 lung cancer patients. Pretreatment blood coagulation tests including PT, aPTT, PTA, INR, D-dimer, fibrinogen levels and platelet counts were evaluated. The plasma level of all coagulation tests revealed statistically significant difference between patient and control group (p

The synergistic effects of new generation chemotherapeutics when combined with cisplatin have encouraged the development of new triplet combination regimens in the treatment of advanced non-small cell lung cancer (NSCLC). The aim of this study was to evaluate the feasibility of triplet chemotherapy using weekly cisplatin-gemcitabine-docetaxel (CGD) for patients with chemotherapy-naive NSCLC. Twenty-seven patients with stage IIIB/IV disease and performance status of 0 to 2 were included in this prospective trial. A combination of gemcitabine 750 mg/m2, cisplatin 25 mg/m2 and docetaxel 25 mg/m2 was administered on days 1, 8 and 15, with cycles repeated every 3 weeks. Leucopenia and/or neutropenia and to a lesser extent thrombocytopenia were the main dose-limiting toxicities. Grade III–IV neutropenia and thrombocytopenia occurred in 26 and 7% of the patients, respectively. Only one patient developed febrile neutropenia. Dose reductions were required in 26% of patients, delays in 44% of patients and early treatment discontinuation in 15% of patients. The overall response rate was 52% and all of them experienced a partial response. The median progression-free (PFS) and overall survival (OS) times were 6 and 13 months, respectively. The one-year survival rate was 46%. In conclusion, weekly administration of CGD is an active first-line therapy with acceptable toxicity in advanced NSCLC patients.

In this paper, Cd2+, Mn2+, Ni2+, Pb2+, and Zn2+ heavy metals ions adsorption properties of commercially obtained Aspergillus tamarii were investigated. The dead biomass was used with a batch system for experiments. The effect of the operating parameters, such as pH, temperature, agitation speed, contact time, initial metal concentration, and biomass dosage of aqueous solution containing Cd2+, Mn2+, Ni2+, Pb2+, and Zn2+ was studied to find biosorption capacity. The optimum pH range for all heavy metal uptakes was 6.0. The experiments were carried out at different temperatures in the range of 20-50 degrees C and the maximum uptake was found to be at 25 degrees C. Heavy metal ion uptake increased with agitation speed until 150rpm. After this agitation speed adsorption capacity slightly decreased. The adsorption equilibrium was obtained at 150min contact time. At the optimal conditions, maximum uptake of Cd2+, Mn2+, Ni2+, Pb2+, and Zn2+ was found to be 51.69, 46.99, 58.74, 98.14, and 54.33%, respectively, by using 1.5g biomass. The interaction between heavy metals and biomass was characterized by FTIR spectroscopy.

Purpose Anorectal malignant melanoma (AMM) is a rare tumor with a poor prognosis. The aim of this study was to investigate the clinicopathological characteristics and treatment outcomes in patients with AMM. Methods The study included 21 patients diagnosed with AMM between 2000 and 2010 that were evaluated with regard to age, sex, disease stage, treatment modality, and survival. Stage I, II, and III were defined as localized primary malignant melanoma, regional lymph node metastasis, and distant metastasis, respectively. Results In all, 12 (57%) patients were female and 9 (43%) were male ; median age was 61 years (range : 30-84 years). Among the 21 patients, 7 (47%) underwent abdominoperineal resection and 8 (53%) were treated using wide local excision. Four (19%) patients were classified as stage I, 10 (48%) as stage II, and 7 (33%) patients as stage III. In total, 10 patients received adjuvant therapy. Median overall and progression-free survival was 12 and 9 months, respectively. The 1-year and 5-year overall survival estimates were 59% and 42%, and progression free survival were 49% and 7%, respectively. Patients aged > 60 years (P = 0.145), female patients (P = 0.076), patients with localized disease (P = 0.045), patients that underwent wide local excision (P = 0.619), and patients that received adjuvant therapy (P = 0.962) had longer survival. Conclusions The prognosis of AMM remains very poor and disease stage is the only predictor of survival. Abdominoperineal resection does not confer an advantage, in terms of survival, in patients with AMM.

Objective: The purpose of this study was to investigate the clinicopathological characteristics and treatment outcomes of patients with adrenocortical carcinoma (AC). Methods: Twenty-four patients (10 females and 14 males) diagnosed with AC between 1998 and 2009 were evaluated. Clinical features and outcomes were reviewed. Results: Median age was 46.5 years. One (4%) patient was classified as stage I, 10 (42%) were classified as stage II, 8 (33%) were classified as stage III and 5 (21%) were classified as stage IV. Tumor sizes ranged from 3 to 22 cm with a mean diameter of 11 cm. Five patients were locally inoperable at initial diagnosis. In addition to surgery, 2 of 19 patients were treated with an adjuvant cisplatin plus etoposide regimen. Sixteen patients were treated with chemotherapy after recurrence. Median survival time was 18 months. The 1- and 5-year overall survival estimates were 73 and 48%, respectively. Mean survival times for male and female patients were 58 and 12 months, respectively (p = 0.046). Early T stage (p = 0.04), lymph node negativity (p < 0.001), the absence of distant metastases (p < 0.001) and early stage (p < 0.001) were correlated with overall survival. Conclusion: AC is a rare disease with a poor prognosis. There are correlations between gender, stage and survival.

The discrepancy between the surgical technique and the type of adjuvant chemotherapy used in clinical trials and patient outcomes in terms of overall survival rates has led to the generation of different adjuvant treatment protocols in distinct parts of the world. The adjuvant treatment recommendation is generally chemoradiotherapy in the United States, perioperative chemotherapy in the United Kingdom and parts of Europe, and chemotherapy in Asia. These options mainly rely on the United States Intergroup-0116, United Kingdom British Medical Research Council Adjuvant Gastric Infusional Chemotherapy, and the Asian Adjuvant Chemotherapy Trial of S-1 for Gastric Cancer and Capeci-tabine and Oxaliplatin Adjuvant Study in Stomach Cancer trials. However, the benefits were evident for only certain patients, which were not very homogeneous regarding the type of surgery, chemotherapy regimens, and stage of disease. Whether the dissimilarities in survival are attributable to surgical technique or intrinsic biological differences is a subject of debate. Regardless of the extent of surgery, multimodal therapy may offer modest survival advantage at least for diseases with lymph node involvement. Moreover, in the era of individualized treatment for most of the other cancer types, identification of special subgroups comprising those who will derive more or no benefit from adjuvant therapy merits further investigation. The aim of this review is to reveal the historical evolution and future reflections of adjuvant treatment modalities for resected gastric cancer patients.

The aim of this retrospective study (from January 2007 to December 2011) was to investigate the efficacy and tolerability of mDCF schedule for chemotherapy-naïve AGC patients.Patients (n = 54) with locally inoperable or distant metastasis and performance status of 0-2 were eligible. The triplet combination chemotherapy consisting of docetaxel 60 mg/m(2) on day 1, cisplatin 60 mg/m(2) on day 1, and 5-fluorouracil 600 mg/m(2) for 5 days of continuous infusion were administered every 21 days, up to nine cycles. Prophylactic G-CSF was not allowed.In all, 36 (67 %) patients were male and 18 (33 %) were female; median age was 59 years. The majority of patients (n = 46, 85 %) had metastatic disease and 8 (15 %) of them had locally advanced disease. Liver metastasis and peritonitis carcinomatosa were found in 20 (43 %) and 18 (39 %) of the 46 cases, respectively. The median cycle of chemotherapy was 6. In assessing 50 patients for response evaluation, one had complete response. Partial response was achieved in 27 (54 %) patients. Seventeen patients (34 %) had stable disease and 5 (10 %) had progressive disease, while 4 % (n = 2) and 11 % (n = 6) of the patients developed severe (grade 3-4) neutropenia and anemia, respectively. During the median follow-up time (6.9 months, range 0.4-24), 28 (52 %) patients died. The overall and progression-free survival were 10.7 [95 % CI 8.9-12.4] and 6.8 [95 % CI 5.8-7.8] months, respectively.Although this was not a prospective comparative study, the mDCF regimen seems to be as effective as the original DCF in AGC with acceptable and manageable side effects.

The aim of this study was to identify and evaluate the clinicopathologic factors and to elucidate the clinical importance of performance status on the outcome of patients with pancreatic cancer.The data of 335 patients with histologically confirmed diagnosis of pancreatic cancer who were treated and followed up between 2000 and 2010 were recorded from medical charts.The median age of the patients was 59 years (range 25-88 years) and 226 (67.5%) were male. The study group comprised localized disease (18%), locally advanced disease (36%) and metastatic disease (46%). The median survival of all patients was 280 days and the 4-year survival rate was 5%. Univariate analysis indicated that initial poor performance status of patients (PS 2-4) was significantly associated with shorter survival in localized (p = 0.015), locally advanced (p = 0.01), metastatic stage (p0.001) and in the whole group (p0.001). Multivariate analyses also showed the same findings except in local disease (p = 0.04 for locally advanced disease, p = 0.002 for metastatic stage, and p0.001 for all stages). In patients with poor performance status, severe weight loss (10%) (p = 0.007), large tumor diameter (3 cm) (p = 0.046), and especially metastatic disease (p0.001) were associated with significantly shorter overall survival.The performance status of a patient is the major prognostic factor predicting overall survival for all stages of pancreatic cancer. Severe weight loss, large tumor, and metastatic disease were found to be unfavorable prognostic factors in patients with poor performance status.

Background Retroperitoneal lymph node dissection is an important treatment modality in nonseminomatous germ cell tumors of the testis. However, the role of more limited surgical approaches such as resection of enlarged lymph nodes only is still controversial. Patients and Methods Between January 1991 and December 2010, charts of 94 patients who underwent resection of enlarged retroperitoneal lymph nodes alone were reviewed. Pathologic findings, local recurrence, and adverse effects were noted after this surgical approach. Results The median age was 25.5 years. Twenty-one (22.6%) patients had lung metastasis, and 5 (5.4%) patients had nonregional lymph node metastasis at the initial visit. Eighty-seven (91.6%) patients received chemotherapy after inguinal orchiectomy, and the other patients had mass resection only for enlarged lymph nodes without prior chemotherapy. In patients who had chemotherapy before surgery, the median retroperitoneal lymph node size before and after chemotherapy cycles was 55 mm and 32.5 mm, respectively. The pathologic assessment of retroperitoneal masses revealed mature teratoma in 51.6% (n = 47) of patients, viable carcinoma in 20.9% (n = 19) of patients, and necrosis or fibrosis in 27.5% (n = 25) of patients. The median follow-up time was 60.2 months (range, 2.7-334.8 months). During follow-up, 5 (5.4%) patients had radiologic relapse at the retroperitoneal area, and 3 patients developed systemic metastases. Six (6.4%) patients died of their disease, 2 (2.1%) patients were alive with disease, 86 (91.5%) patients were healthy at the last follow-up. Ejaculation status was recorded in 56 patients. Antegrade ejaculation had preserved in 53 (94.6%) of these patients. Conclusions Resection of enlarged lymph node metastases alone is a reasonable treatment option for patients with nonseminomatous germ cell tumors.

The aim of this study was to investigate the influence of a marker half-life (MHL) on relapse in nonseminomatous germ cell testicular tumor patients.MHL was retrospectively analyzed in relapsed (n = 37) and nonrelapsed patients (n = 28) undergoing first-line chemotherapy (CT). Before CT and after the second cycle of CT, serum α-fetoprotein (AFP) and β-human chorionic gonadotropin levels were measured for MHL analysis. The International Germ Cell Cancer Collaborative Group risk classification system was used to assess the correlation between MHL and relapse. MHL was calculated according to a logarithmic formula.Median follow-up was 25 months (range, 6 to 96 mo). A statistically significant difference was not observed between initial AFP (P = 0.266) and β-human chorionic gonadotropin (P=0.092) in both patient groups. MHL was statistically different between the relapsed and nonrelapsed patients with a good, intermediate, and poor prognosis, except for the half-life of AFP in patients with a poor prognosis.MHL is an indicator that predicted recurrence. Patients with an MHL longer than expected should be investigated to improve the effectiveness of treatment and should be treated with a recovery regimen.

To determine the characteristics and outcome of patients with refractory gestational trophoblastic neoplasia (GTN) after primary chemotherapy (CTx). The outcome of low- and high-risk patients with refractory GTN (n = 14, 37%) was compared to those with non-refractory GTN (n = 24, 63%). Methotrexate treatment was used for patients with low-risk disease and EMA/CO for patients with high-risk disease. Median follow-up time was 53 months (range 1–173 months). All non-refractory patients and 11 refractory patients (79%) survived (p = 0.015). Factors related to resistance to primary CTx was age (p = 0.012), duration between causal pregnancy and initial treatment (p = 0.003), surgery (p = 0.014), hCG level before CTx (p = 0.09) and half-life of hCG (p = 0.061). Six out of 10 low-risk refractory patients treated with EMA/CO regimen in the second-line setting had been followed by no evidence of disease. Nine of 38 (24%) patients underwent surgery (TAH ± BSO) for GTN. All of the patients treated with surgery were in the non-refractory group, but none of refractory patients underwent surgery (p = 0.014). Surgery and EMA/CO regimen are one of the main factors that play a role in the management of refractory low-risk GTN.

Background Classic Kaposi’s sarcoma (CKS) affects an elderly population; it is important to have effective treatment options with high activity and relatively low toxicity, and availability to be used for long periods. Objective We investigated the activity and safety of single-agent etoposide with an oral administration schedule in patients with advanced CKS. Methods Histologically confirmed, CKS patients were eligible for study. All had a negative test for HIV and good performance status. All patients received oral etoposide 50 mg twice daily for 10 days every 3 weeks. Results Thirty patients (median age 66 and 22 males) were enrolled into the study. The majority of them had non-metastatic, local advanced disease and symptoms in nearly half of patients. Complete and partial responses were observed in 10% and 77% of patients, respectively, giving an overall response rate of 87%. Stable disease occurred in the other 13% of patients. Treatment was well tolerated. Grade IV toxicity was not observed. Haematological toxicity was the principal dose-limiting side effect. Severe leucopaenia and neutropaenia were observed in 7% and 10% of patients respectively. No patient was complicated by febrile neutropaenia. Mild-moderate anaemia observed frequently, but only 3% of patients had severe anaemia and severe thrombocytopaenia was not observed. The 5-year overall survival rate was 92%. Conclusions Single-agent oral etoposide is an effective treatment option and is acceptably toxic and easily administered. Therefore, we recommend the single agent of oral etoposide as the first-line chemotherapy for advanced CKS.

This study reports the development of a novel sensing material that reports on analyte concentrations via diffraction of visible light from polymerized crystalline colloidal arrays (PCCA). The PCCA contains periodic crystalline colloidal array (CCA) of spherical polystyrene colloids. This new method permanently locks the order of the CCA by embedding the CCA into a polymer network. These materials are mostly used in the development of novel materials which are basically called sensors for metal ions and all kinds of organic molecules. The polymer around the crystalline colloid can be functionalized with some recognition molecule, making these materials useful as optical sensors. We developed a sensor, utilizing crown ether, 2-aminomethyl-18-crown-6 (2A18C6) as the recognition agent, that detects K(+) in the concentration range from 5 to 160 ppm.

Radiotherapy (RT) with concomitant chemotherapy (CT) has improved the therapeutic outcome of patients with locally advanced nasopharyngeal carcinoma (LANC). However, the importance of induction CT before definitive therapy is still undefined. Patients (n=59) who had LANC were included in this retrospective study. They received induction CT consisting of cisplatin and docetaxel followed by definitive RT with cisplatin. The median age was 49 years (18-68). All patients were of stages II (15%), III (63%) and IV (22%). Fifty eight patients could receive 3 cycles of CT. Except one patient, there was no grade 3 or 4 toxicity during induction CT. Chemoradiotherapy could be given to 49 patients (83%). Twelve percent of patients had complete response after induction CT and this number had increased to 95% after the completion of the therapy. Objective responses (complete and partial) were 100% after the completion of the therapy. Median follow up time was 29 months. Nine patients had relapse (2 had local only, 4 distant, 3 local and distant). Three patients who had both local and distant relapse died during follow-up. Three year overall and progression free survival rates were 94.9% and 84.7%, respectively. Induction CT with docetaxel and cisplatin is a feasible and tolerable treatment for patients with LANC.

The objective of this study was to analyze the extent of stressful life events' etiology and to compare socio-demographic and medical characteristics of the presence and absence of stress in Turkish cancer patients. Patients with cancer who attended ambulatory patient care units answered the questionnaires. Medical information was reviewed from chart data. The study population comprised 465 women (60.5%) and 303 men (39.5%), in total 768 cases. The median age was 53 years, ranging between 18 and 94. Three-hundred and twenty patients (41.7%) had at least one type of stress since last year of the time of initial diagnosis. Among patients had stress, the median number of stress modalities presented was 1 (range 1-6). Death, lack of livelihood, quarrel, illness, and debt almost always consisted of stress types. History of stress within last year was found more in women (66.3% vs. 56.5%, P = 0.006) and overweight patients (57.5% vs. 47.2%, P = 0.005). Similarly, among cancer types, only patients with breast cancer (41.9% vs. 31.7%, P = 0.04) had lived more stressful situation. However, the married patients (72.2% vs. 80.6%, P = 0.03) had less stress. Patients with gastric cancer had more frequent debt (29.0%, P < 0.001) and lack of livelihood history (21.4%, P = 0.001). Additionally, in lung cancer patients, their rate of livelihood difficulty was highly less than average (2.4%, P = 0.003). We found that overweight patients had more illness history (68.9% vs. 51.6%, P = 0.004), patients who were not working had more death history (89.7% vs. 78%, P = 0.01), and female patients had more quarrel history (78.2% vs. 60.5%, P = 0.002). Likewise, history of debt in patients who is a member of large family (56.2% vs. 27.4%, P = 0.01) was more frequent. Additionally, the lack of livelihood was prominent in urban patients (92.8% vs. 78.6%, P = 0.002) and in patients with low income (48.5% vs. 66.7%, P = 0.004). The question of whether or not psychological factors originated from stressful life events have an influence on cancer initiation and progression is still unanswered after several decades of research. Future studies might benefit from better well-designed articulated hypotheses, prospective design, and large study populations to ensure adequate knowledge.

The aim of this study was to evaluate the efficacy of active surveillance after radical orchiectomy in patients with clinical stage I nonseminoma.Between 2002 and 2009, the charts of 80 patients who were offered active surveillance were studied retrospectively. Patients underwent clinical, radiologic, and biochemical examinations according to NCCN follow-up guidelines in nonseminoma.70 of 80 patients who accepted this strategy were analyzed. 12 of the 70 patients (17%) had relapses with a median follow-up of 18.5 months (6-76). Relapses were found in retroperitoneal lymph nodes in 3 patients. 5 patients had marker relapse, and 4 patients developed both marker relapse and retroperitoneal lymph node metastases. 10 of the 12 patients (83%) had relapsed within 1 year. There were no statistically significant differences in lymphovascular invasion and germ cell components between relapsed and non-relapsed patients. 11 of the 12 patients were treated with cisplatinbased combination chemotherapy, and 1 patient underwent retroperitoneal lymph node dissection. Only 2 patients underwent primary retroperitoneal lymph node dissection for rest nodules.Surveillance could be a reliable strategy in compliant stage I nonseminoma patients. Recurrences can be detected early and treated successfully.

Objective: Compared to the cutaneous melanoma, noncutaneous melanomas are relatively rare and have a distinct pattern of behavior. We performed this study to define the clinical characteristics and outcomes of patients with noncutaneous melanomas and emphasize how they differ from cutaneous melanomas. Methods: 216 patients who were diagnosed with noncutaneous melanoma were assessed and their medical records between 2000 and 2010 were retrieved from the cancer registry. 475 patients with cutaneous melanoma were used for comparison. Results: Of the 216 noncutaneous melanoma patients, 83 had mucosal melanoma, 101 had ocular melanoma and 32 had unknown primaries. For mucosal melanoma, the head and neck was the most common anatomic site (53%), followed by the gastrointestinal tract (37%), female genital (6%) and urinary tract (4%). The majority of the ocular melanomas (94%) originated in the uvea. 32 patients demonstrated a primary unknown disease with regional metastasis as the dominant behavior (72%). Age was found to be statistically significantly different among melanoma patients (p < 0.001). Younger patients had more cutaneous and unknown primary melanomas, whereas older patients had more ocular and mucosal melanoma. In subset analyses, we found significant differences between cutaneous and ocular (p = 0.038) or mucosal (p < 0.001) melanomas. The ratios of metastasis on admission were higher in patients with mucosal (27.7%) and unknown primary (28.1%) melanomas, and lower for ocular (3%) melanomas (p < 0.001). Patients with cutaneous melanoma had an intermediate (12%) ratio. Patients with ocular melanoma had better outcome than patients with other melanoma sites (p < 0.05). While overall survival for cutaneous melanoma was significantly negatively correlated with male gender (p < 0.001), advanced stages (p < 0.001) and old age (p = 0.005), stage IV disease was the only independent prognostic factor in patients with ocular melanoma (p = 0.006). No prognostic factor for outcome was found for either mucosal or unknown primary melanomas. Conclusion: The clinical presentations and prognoses of different primary sites of melanoma are distinctive. Therefore, approaches to these melanomas should be different.