Cell encapsulation in gelatin methacryloyl bioinks impairs microscale diffusion properties

Light-assisted bioprinted gelatin methacryloyl (GelMA) constructs have been used for cell-laden microtissues and organoids. GelMA can be loaded by desired cells, which can regulate the biophysical properties of bioprinted constructs. We study how the degree of methacrylation (MA degree), GelMA mass concentration, and cell density change mass transport properties. We introduce a fluorescent-microscopy-based method of biotransport testing with improved sensitivity compared to the traditional particle tracking methods. The diffusion capacity of GelMA with a higher MA significantly decreased compared to a lower MA. Opposed to a steady range of linear elastic moduli, the diffusion coefficient in GelMA varied when cell densities ranged from 0 to 10 × 106 cells/ml. A comparative study of different cell sizes showed a higher diffusivity coefficient for the case of larger cells. The results of this study can help bioengineers and scientists to better control the biotransport characteristics in light-assisted bioprinted microtissues and organoids.

3D Bioprinted Hydrogel Microfluidic Devices for Parallel Drug Screening

Conventional high-throughput screening (HTS) platforms suffer from the need for large cell volumes, high reagent consumption, significant assembly cost, and handling efforts. The assembly of three-dimensional (3D) bioprinted hydrogel-based microfluidic chips within platforms can address these problems. We present a continuous and seamless manufacturing approach to create a bioprinted microfluidic chips with a circular pattern scalable toward HTS platforms. Digital light processing 3D bioprinting is used to tune the local permeability of our chip, made of polyethylene glycol diacrylate and cell-laden gelatin methacryloyl, for creating predefined gradients of biochemical properties. We measured the flow-induced physical characteristics, the mass transport of drug agents, and the biological features of the proposed chip. We measured reactive oxygen species from the encapsulated cells through an integrated process and showed the capacity of the hydrogel-based chip for creating drug/agent gradients. This work introduces a chip design based on a hydrogel that can be changed and could be used for modern HTS platforms such as in vitro organoids.

Digital Light Processing Bioprinting Advances for Microtissue Models

Digital light processing (DLP) bioprinting has been widely introduced as a fast and robust biofabrication method in tissue engineering. The technique holds a great promise for creating tissue models because it can replicate the resolution and complexity of natural tissues and constructs. A DLP system projects 2D images onto layers of bioink using a digital photomask. The resolution of DLP bioprinting strongly depends on the characteristics of the projected light and the photo-cross-linking response of the bioink microenvironment. In this review, we present a summary of DLP fundamentals with a focus on bioink properties, photoinitiator selection, and light characteristics in resolution of bioprinted constructs. A simple guideline is provided for bioengineers interested in using DLP platforms and customizing technical specifications for its design. The literature review reveals the promising future of DLP bioprinting for disease modeling and biofabrication.

Should we report Breslow density, a new concept in cutaneous melanoma?

INTRODUCTION

Breslow density is a newly defined biomarker, independent of Breslow thickness. We aimed to investigate the relationship of Breslow density with other clinicopathological prognostic factors and its effect on the overall survival and disease-free survival in patients with cutaneous melanomas.

MATERIALS & METHODS

This was a single-centre retrospective study of patients (n = 19) diagnosed with cutaneous malignant melanomas in our hospital between 2011 and 2019 were included in the study. The exclusion criteria were in situ melanomas, punch or incisional biopsies and metastasis at the time of the diagnosis. Breslow density was determined by reevaluating slides obtained at the time of the initial diagnoses. The effect of Breslow density on survival was determined using univariate and multivariate Cox proportional risk analyses.

RESULTS

In terms of the overall survival, mortality risk increased as Breslow density increased (p = 0.044). Breslow density was not significantly associated with the overall survival in the multivariate model (p = 0.078). In terms of disease-free survival, the risk of metastasis or recurrence increased 1.229- fold in accordance with an increase in Breslow thickness (CI: 1.057-1.428), whereas increased Breslow density increased the metastasis or recurrence risk 1.059-fold (CI: 1.008-1.112). In the multivariate model, only Breslow density was statistically significant (p = 0.046).

CONCLUSIONS

As a semi-quantitative and subjective measurement, Breslow density is not a completely accurate representation of the invasive tumour load. However, the measurement is practical and low cost and requires no additional equipment. Therefore, Breslow density can be measured in every laboratory. Considering the value of Breslow density in predicting the prognosis in patients with cutaneous melanomas and strong inter-observer compliance observed in the present study, we believe that it would be useful to include this measurement in pathology reports.

Multi-material digital light processing bioprinting of hydrogel-based microfluidic chips

Recent advancements in digital-light-processing (DLP)-based bioprinting and hydrogel engineering have enabled novel developments in organs-on-chips. In this work, we designed and developed a multi-material, DLP-based bioprinter for rapid, one-step prototyping of hydrogel-based microfluidic chips. A composite hydrogel bioink based on poly-ethylene-glycol-diacrylate (PEGDA) and gelatin methacryloyl (GelMA) was optimized through varying the bioprinting parameters such as light exposure time, bioink composition, and layer thickness. We showed a wide range of mechanical properties of the microfluidic chips for various ratios of PEGDA:GelMA. Microfluidic features of hydrogel-based chips were then tested using dynamic flow experiments. Human-derived tumor cells were encapsulated in 3D bioprinted structures to demonstrate their bioactivity and cell-friendly environment. Cell seeding experiments then validated the efficacy of the selected bioinks for vascularized micro-tissues. Our biofabrication approach offers a useful tool for the rapid integration of micro-tissue models into organs-on-chips and high-throughput drug screening platforms.

Cancer Stem Cells in Tumor Modeling: Challenges and Future Directions

Microfluidic tumors-on-chips models have revolutionized anticancer therapeutic research by creating an ideal microenvironment for cancer cells. The tumor microenvironment (TME) includes various cell types and cancer stem cells (CSCs), which are postulated to regulate the growth, invasion, and migratory behavior of tumor cells. In this review, the biological niches of the TME and cancer cell behavior focusing on the behavior of CSCs are summarized. Conventional cancer models such as three-dimensional cultures and organoid models are reviewed. Opportunities for the incorporation of CSCs with tumors-on-chips are then discussed for creating tumor invasion models. Such models will represent a paradigm shift in the cancer community by allowing oncologists and clinicians to predict better which cancer patients will benefit from chemotherapy treatments.

Multi-Organs-on-Chips for Testing Small-Molecule Drugs: Challenges and Perspectives

Organ-on-a-chip technology has been used in testing small-molecule drugs for screening potential therapeutics and regulatory protocols. The technology is expected to boost the development of novel therapies and accelerate the discovery of drug combinations in the coming years. This has led to the development of multi-organ-on-a-chip (MOC) for recapitulating various organs involved in the drug-body interactions. In this review, we discuss the current MOCs used in screening small-molecule drugs and then focus on the dynamic process of drug absorption, distribution, metabolism, and excretion. We also address appropriate materials used for MOCs at low cost and scale-up capacity suitable for high-performance analysis of drugs and commercial high-throughput screening platforms.

Attitudes of Marmara university third grade students towards dating violence

Introduction and Objective

The definition of dating violence is “All of the words, mimics and behaviors that involve the use of painful or hurtful physical, psychological force and threats against the partner”. In the studies conducted, it was determined that one of the groups most at risk in terms of exposure to violence is the adolescent and young adult age group. Prevention of violence in the dating period mayal so prevent many types of violence that may occur in the future. Therefore, it is important to determine the attitudes of individuals in the age group at risk towards violence. The aim of there search is to investigate the attitudes of students studying in the 3rd grade in the Medicine, Pharmacy and Dentistry departments at Marmara University against the dating violence and their relationship with various variables.

Methods

The study is qualitative and there search is cross-sectional. There search population consists of students studying in the third grade in the departments of medicine, pharmacy and dentistry at M.U. As a data collection tool, a 15-question questionnaire with sociodemographic variables and attitude scales for dating violence were used.

Results

Participants: 40.5% consist of Medical faculty, 25.90% Pharmacy faculty and 33.5% Dentistry faculty students. Male participants 'attitudes cores towards psychological violence by men in flirting were higher than female participants' attitudescores towards psychological violence by men. When the attitude scales of the participants towards flirting violence were evaluated according to the faculty they studied, no significant difference was found.

Conclusions

This research has revealed that, like many studies in the literature, men's attitude scores towards dating violence are higher than women. While there is a statistically positive relationship between violence attitude scores towards cigarette smoking;there is a negative relationship between the duration of flirting and violence attidue scores.

Key messages

The dating violence is preventable health problem. The dating violence is silent war.

3D Printing metamaterials towards tissue engineering

The rapid growth and disruptive potentials of three-dimensional (3D) printing demand further research for addressing fundamental fabrication concepts and enabling engineers to realize the capabilities of 3D printing technologies. There is a trend to use these capabilities to develop materials that derive some of their properties via their structural organization rather than their intrinsic constituents, sometimes referred to as mechanical metamaterials. Such materials show qualitatively different mechanical behaviors despite using the same material composition, such as ultra-lightweight, super-elastic, and auxetic structures. In this work, we review current advancements in the design and fabrication of multi-scale advanced structures with properties heretofore unseen in well-established materials. We classify the fabrication methods as conventional methods, additive manufacturing techniques, and 4D printing. Following a comprehensive comparison of different fabrication methods, we suggest some guidelines on the selection of fabrication parameters to construct meta-biomaterials for tissue engineering. The parameters include multi-material capacity, fabrication resolution, prototyping speed, and biological compatibility.

Evaluation of nasolabial aesthetics by different groups in operated unilateral cleft lip and palate

AIM

The aim of this study is to evaluate and to compare the perception of nasolabial aesthetic by experienced professionals, inexperienced professionals, cleft patients and laypersons in children with unilateral cleft lip and palate (UCLP) using the Asher-McDade Scoring System.

MATERIALS AND METHODS

In this retrospective study, 75 patients who applied to Ege University, Faculty of Dentistry, Department of Orthodontics and whose primary surgery operations were completed in Ege University, Faculty of Medicine Department of Plastic and Reconstructive Surgery, were evaluated from the extra-oral and profile photographs. All photographs were arranged according to Asher-McDade Scoring System and evaluated by 4 different groups. 5 people were evaluated in each group consisting of experienced professionals, inexperienced professionals, cleft patients and the laypersons. Nasal form, nasal deviation, vermilion border and nasal profile were evaluated in 5 different categories according to Asher-McDade Scoring System. Statistical analyzes were performed using STATA 11 and MEDCALC software. G Power, Fleiss Kappa, Weighted Kappa and Friedman statistical analyzes were performed for determination of number of individuals, interobserver and intraobserver reliability and comparison of scoring between groups, respectively.

RESULTS

In this study, the interobserver agreement was found to be between 0.75 and 0.80 that shows a high degree of reliability. In the comparision made between the groups; experienced professionals and inexperienced professionals; there was moderate agreement in nasal profile scoring (WK 0.2857) (-0.9673/0.6596). There was agreement between experienced professionals and cleft patients in mostly vermilion border (WK 0.5454) (-0.1643/1.0000). There was no agreement between vermilion border between inexperienced professionals and cleft patients (WK 0.9230) (-1.0000/-0.2878), and compliance with the nasal profile mostly (WK 0.5454) (-0.1643/1.0000). There was a similar insignificant agreement between experienced and inexperienced professionals, cleft patients among the laypersons, at all values (WK 0,0000) (-0.0000/0.0000). According to the scoring results of the photographs for experienced professionals; nasal form, nasal deviation, vermilion border and nasal profile were evaluated as bad and close the bad (4.00±0.00, 3.80±0.44, 3.80±0.44, 3.60±0.54); it was found fair and near the bad for inexperienced professionals (3.00±0.00, 3.00±0.00, 3.40±0.54 3.20±0.44) and close the bad for cleft patients (3.60±0.54, 3.80±0.44, 3.80±0.44, 3.40±0.54). But it was found to be acceptable and good for laypersons (2.00±0.00, 2.00±0.00, 2.40±0.54, 1.40±0.54). Laypersons showed statistically significant difference in the evaluation of nasal form, nasal deviation and nasal profile from the cleft patients (P<0.05), while they showed statistically significant difference in all the score from the experienced professionals (P<0.05, P<0.01).

CONCLUSION

The aesthetic appearance of nasolabial region is one of the important tools to evaluate the success of the treatment in patients with CLP. The success of primary surgery has one of the most important effects for nasolabial aesthetics on patients with clefts. As a result of the study, the evaluation of cleft patients was found to be similar to that of experienced professionals and lower than that of inexperienced professionals and the laypersons. This result shows us that patients with CLP have higher awareness of self-perception, but these patients may have psychosocial problems ranging from low self-esteem to social isolation risk.

Factors associated with patient activation in a Turkish population with diabetes and/or hypertension

Background

Patient activation (PA), which is known to improve health outcomes, describes the knowledge, skills and confidence a person has in managing their own health care. We investigated the extent of PA and associated factors in adults with diabetes (DM) and/or hypertension (HT). This study is the first in Turkey evaluating PA, using the Patient Activation Measure (PAM) scale. The results of the study provide practitioners with information on the characteristics of patients who need support to increase their activation.

Methods

We conducted this cross-sectional study in 14 Family Health Centers in Istanbul. The participants were DM and/or HT patients. A questionnaire including the PAM, questions on patient characteristics, life style behaviors, healthcare utilization and health status was applied to 431 patients. Based on PAM score, patients were classified into two activation levels: level 1-2 (poor activation) and level 3-4 (good activation). χ2, t-test and logistic regression (LR) analysis were used. LR analysis was performed for all participants and for women and men separately.

Results

Of 431 patients (mean age: 63.6), 65% were women; 45% had a poor activation level (PAL). Based on LR analysis; low socioeconomic status (SES) (OR = 1.6; 95% CI:1.01-2.5), being illiterate (OR = 3.9, 95% CI: 1.5-10.7), being primary school graduate (OR = 2.1, 95% CI:1.1-4.2), lack of adult vaccination (OR = 1.9, 95% CI:1.1-3.1), higher BMI (OR = 1.1, 95% CI: 1.09-1.13) and worse self-reported health (OR = 1.2, 95% CI: 1.1-1.3) were factors associated with low PAL. The latter was associated with low PAL for both sexes; high BMI was an associated factor only among women, while low SES and lack of vaccination were factors only in men.

Conclusions

Almost half of the patients had low activation level in our sample. Associated factors may serve as the basis for the development of interventions needed to enhance activation for patients with DM/HT.

Key messages

Low patient activation is associated with low level of education, low SES, high BMI, lack of vaccination and worse self-reported health. The factors associated with patient activation vary by gender. A qualitative study with patients having different levels of activation would be useful to understand the underlying motivations.

Evaluation of hyaluronic matrix efficacy in sinus augmentation: a randomized-controlled histomorphometric and micro-computed tomography analysis

The objective of the present study was to test the hypothesis that the addition of hyaluronic acid-based matrix to collagenated heterologous bone graft for sinus augmentation would enhance bone formation compared to collagenated heterologous bone graft alone in the early healing period, by micro-computed tomography and histomorphometry. Thirteen systemically healthy patients requiring bilateral two-stage maxillary sinus augmentation (residual crest height≤4mm) were enrolled in this split-mouth prospective randomized controlled study. One sinus side as a control group was grafted with only collagenated heterologous bone graft; the other region as a test group was grafted with hyaluronic matrix and collagenated heterologous bone graft. Bone biopsy samples were taken after 4 months during the dental implant surgery and analyzed using micro-computed tomography and histomorphometric parameters. According to the micro-computed tomography and histomorphometric results, a significantly higher percentage of new bone was observed in the test group when compared to the control group after 4 months of healing. This study confirmed the hypothesis that the addition of hyaluronic matrix to collagenated heterologous bone graft for sinus augmentation enhances bone formation compared to collagenated heterologous bone graft alone in the early healing period.

Hysterosalpingography prior to the gonadotropin stimulated intrauterine insemination improves clinical pregnancy rates in women with unexplained infertility

PURPOSE OF INVESTIGATION

Gonadotropin stimulated intrauterine insemination (IUI) cycles performed following one month after hysterosalpingography (HSG) are associated with improvement in clinical pregnancy rates in unexplained infertile couples.

MATERIALS AND METHODS

A retrospective cohort study was performed between 2008 and 2014. A total of 92 unexplained infertile couples undergoing their first cycle IUI stimulated by gonadotropins were included in the analysis. Participants were classified into two groups according to IUI cycles performed one month (Group A, n = 25 cycles) or longer than one month (Group B, n = 67 cycles) after the HSG procedure.

RESULT

The overall clinical pregnancy rate was found as 25% (23 clinical pregnancies / 92 cycles). Clinical pregnancy rate was 44 % (11/25) for Group A and 17.9 % (12/67) for Group B. In Group A, there were significantly higher clinical pregnancy rates compared to Group B (OR: 3.6, 95% CI, 1.3-9.8; p = 0.012).

CONCLUSIONS

It has been demonstrated that fertility improving effect of HSG was most prominent in the first six months after procedure. Likewise, in gonadotropin stimulated IUI cycles performed following one month after HSG, there seems to be an improvement in pregnancy rates in unexplained couples. In unexplained cases, it may be a reasonable approach to plan IUI cycles in the first month after HSG in clinical practice.

An assessment of the ship drag penalty arising from light calcareous tubeworm fouling

A test coupon coated with light calcareous tubeworm fouling was scanned, scaled and reproduced for wind-tunnel testing to determine the equivalent sand grain roughness ks. It was found that this surface had a ks = 0.325 mm, substantially less than the previously reported values for light calcareous fouling. This result was used to predict the drag on a fouled full scale ship. To achieve this, a modified method for predicting the total drag of a spatially developing turbulent boundary layer (TBL), such as that on the hull of a ship, is presented. The method numerically integrates the skin friction over the length of the boundary layer, assuming an analytical form for the mean velocity profile of the TBL. The velocity profile contains the roughness (fouling) information, such that the prediction requires only an input of ks, the free-stream velocity (ship speed), the kinematic viscosity and the length of the boundary layer (the hull length). Using the equivalent sandgrain roughness height determined from experiments, a FFG-7 Oliver Perry class frigate is predicted to experience a 23% increase in total resistance at cruise, if its hull is coated in light calcareous tubeworm fouling. A similarly fouled very large crude carrier would experience a 34% increase in total resistance at cruise.

Isokinetic Evaluation of Knee Extensor/Flexor Muscle Strength in Behcet's Patients

BACKGROUND

Behçet's disease (BD) is an idiopathic, multisystemic, progressive disease. The purpose of this study is to compare the knee flexor and extensor isokinetic muscle strengths of Behcet's patients with that of healthy subjects.

METHODS

Twenty-five (13 male and 12 female) patients with BD and 25 (15 male and 10 female) healthy individuals were included in the study. Velocities of 90°/sec, 120°/sec, and 150°/sec were used for the isokinetic muscle strength testing. Patients with active inflammatory knee arthritis were excluded. Peak torque (Nm) and peak torque adjusted to body weight (%) were taken into consideration for comparison between study groups.

RESULTS

Compared to healthy controls, there was a statistically significant decrease in both the bilateral knee extensor and flexor muscle isokinetic peak torques(Nm) as well as the peak torques adjusted to body weight (%) at velocities of 90°/sec, 120°/sec and 150°/sec in patients with BD (p < 0.05). However, there was no significant difference in the agonist-antagonist ratio of the isokinetic peak torques of knee muscles between the two groups.

CONCLUSION

In light of these findings, we have concluded that both knee flexor and extensor isokinetic muscle strengths are lower in BD. We therefore recommend careful monitoring of patients with BD in terms of muscle strength.

Kidneys at higher risk of discard: expanding the role of dual kidney transplantation

Half of the recovered expanded criteria donor (ECD) kidneys are discarded in the United States. A new kidney allocation system offers kidneys at higher risk of discard, Kidney Donor Profile Index (KDPI)>85%, to a wider geographic area to promote broader sharing and expedite utilization. Dual kidney transplantation (DKT) based on the KDPI is a potential option to streamline allocation of kidneys which otherwise would have been discarded. To assess the clinical utility of the KDPI in kidneys at higher risk of discard, we analyzed the OPTN/UNOS Registry that included the deceased donor kidneys recovered between 2002 and 2012. The primary outcomes were allograft survival, patient survival and discard rate based on different KDPI categories (<80%, 80-90% and >90%). Kidneys with KDPI>90% were associated with increased odds of discard (OR=1.99, 95% CI 1.74-2.29) compared to ones with KDPI<80%. DKTs of KDPI>90% were associated with lower overall allograft failure (HR=0.74, 95% CI 0.62-0.89) and better patient survival (HR=0.79, 95% CI 0.64-0.98) compared to single ECD kidneys with KDPI>90%. Kidneys at higher risk of discard may be offered in the up-front allocation system as a DKT. Further modeling and simulation studies are required to determine a reasonable KDPI cutoff percentile.

Maternal soluble vascular cytoplasmic adhesion molecule-1 and fibronectin levels in early- and late-onset preeclamptic pregnancies

OBJECTIVE

The purpose of this study was to investigate maternal plasma soluble vascular cytoplasmic adhesion molecule-1 (sVCAM-1) and fibronectin levels in the patients with early-onset preeclampsia (EOP) and late-onset preeclampsia (LOP) and also to determine whether different mechanisms are involved in these two forms of disorders.

MATERIAL AND METHODS

The authors performed a case control study consisting of randomly selected 80 healthy pregnant women (group 1 = control group) and 80 preeclamptic women (group 2 = defined study group). Study group consisted of43 patients with EOP and 37 patients with LOP. sVCAM-1 and fibronectin concentrations were measured by enzyme-linked immunosorbent assay (ELISA) and the findings were compared between the groups.

RESULTS

The mean levels of sVCAM-1 and fibronectin were significantly higher in the LOP group than those in the normotensive group (p = 0.043 and 0.010 respectively). Markers were significantly different between the two hypertensive groups of pregnancy. The EOP group had a higher level of sVCAM-1 and fibronectin concentration than the LOP group (p = 0.01, for both markers). There was a positive correlation both between the values of plasma fibronectin and the systolic-diastolic blood pressure measurements (r:0.43 and 0.44, respectively), and between sVCAM-1 and the systolic/diastolic blood pressure measurements (r = 0.54 and 0.64, respectively).

CONCLUSION

Increased plasma levels of fibronectin and sVCAM-1 were found in the preeclamptic patients, especially in those with early-onset preeclampsia. These markers might be related to the pathogenesis of different types of preeclampsia.

Neuroprotective effects of carvacrol and pomegranate against methotrexate-induced toxicity in rats

BACKGROUND

Studies related to the use of various antioxidant and anti-inflammatory drugs to decrease the toxic side effects related to MTX have been carried out. However, since no medicine providing full protection against the side effects of MTX has been discovered, the discovery of new agents is required.

AIM

The aim of this study was to determine whether methotrexate (MTX) causes oxidative stress and an inflammatory response in sciatic nerve, as well as whether carvacrol (CAR) and pomegranate (POM) have protective effects against the resulting oxidative stress and inflammatory response.

MATERIALS AND METHODS

32 adult male Wistar albino rats were used in the study. The animals were divided into 4 groups: Group C: the rats were not given any medication; Group MTX: On study day 2, the rats were given a single dose of 20 mg/kg MTX, administered intraperitoneally; Group MTX+CAR: On study day one, the rats were administered a single dose of 73 mg/kg CAR intraperitoneally. On study day two, a single dose of 20 mg/kg MTX was administered intraperitoneally; Group MTX+POM: For seven days starting from the study day one, rats were given 225 mg/kg POM extract once a day through orogastric gavage. On study day two, a single dose of 20 mg/kg MTX was administered intraperitoneally. All animals were sacrificed on the day eight. TOS, TAS, MDA, TNF-α and IL-1β levels were evaluated in the sciatic nerve tissue.

RESULTS

In comparison to the control group, a decrease in TAS levels and an increase in TOS, MDA, IL-1β and TNF-α levels were detected in the MTX group. Compared to the MTX group, the MTX+CAR group had a significant increase in TAS level and significant decreases in TOS, MDA, IL-1β and TNF-α levels. In comparison to the MTX group, the MTX+POM group had a significant decrease in MDA, IL-1β and TNF-α levels. When the MTX+CAR and MTX+POM groups were compared, the TNF-α level measured was lower in the MTX+CAR group.

CONCLUSIONS

In this work, we have shown that MTX causes a significant oxidative stress and inflammatory response in rats' sciatic nerve tissue and that CAR had an antioxidant effect in this system. Furthermore, we have proven, for the first time, that both CAR and POM decreased the pro-inflammatory response.

A modified DCF regimen as primary treatment for patients with metastatic gastric cancer

PURPOSE

To retrospectively assess the efficacy and toxity of a modified docetaxel, cisplatin, fluorouracil (mDCF) regimen as primary treatment in patients with metastatic gastric cancer (MGC).

METHODS

mDCF included folinic acid 400 mg/m(2) (day 1) + 5-fluorouracil (5-FU) 400 mg/m(2) i.v. bolus (day 1) + 5-FU 2400 mg/m(2) 46-h infusion (days 1 and 2) + docetaxel 60 mg/m(2) (day 1) + cisplatin 50 mg/m(2) (day 1) and was administered once every two weeks in MGC patients.

RESULTS

Eighty-nine patients (median age 59 years, range 31-79) were enrolled. The median number of courses was 6 (range 2-12), and the total number was 492. The median follow-up duration was 8.6 months (range 2-14). Three (3.3%) patients showed complete response, 21 (23.6%) partial response, 36 (40.4%) stable disease, and progression was observed in 29 (32.6%) patients. The median progression- free survival (PFS) rate was 7 months (95% CI 5.7-8.2), and the median overall survival (OS) rate was 11 months (95% CI 9.7-12.2). The most common toxicity was neutropenia, which was observed in 52 (58.4%) patients.

CONCLUSION

mDCF with reduced drug doses, given every two weeks, is a rather efficient regimen for MGC patients.

Secondary hematological malignancies after treatment of non-metastatic breast cancer

PURPOSE

To determine the frequency of secondary hematological malignancies in non-metastatic breast cancer (BC) patients who received adjuvant chemotherapy and radiotherapy.

METHODS

Data of BC patients followed at Hacettepe University Institute of Oncology, Department of Medical Oncology between 2004 and 2010 were retrospectively analysed.

RESULTS

There were 1,475 BC patients followed between 2004 and 2010 at our department; 1,319 (89.4%) of them had not metastatic disease. One thousand, one hundred eighty three (89.7%) early-stage BC patients received at least one treatment modality (radiotherapy and/or chemotherapy). The number of patients receiving only chemotherapy or only radiotherapy were 228 (17.3%) and 117 (8.9%), respectively. Eleven (1%) out of 1,066 BC patients receiving adjuvant/neoadjuvant chemotherapy were also treated with granulocyte colony stimulating factor (G-CSF). The frequency of secondary hematological malignancies among adjuvant or neoadjuvant chemotherapy BC patients was 0.56% (6/1,066); it was 0.59% (7/1,183) among radiotherapy and/or chemotherapy treated non-metastatic BC patients. Five patients developed acute myeloid leukemia (AML); 3 of them were AML-FAB M3 and 2 could not be subclassified. The 6th patient had multiple myeloma and the 7th had diffuse large B cell lymphoma (DLBCL). However, the latter did not receive cytotoxic chemotherapy for BC.

CONCLUSION

Treatment-associated secondary hematological malignancies, especially myeloid leukemias, are a growing problem due to high prevalence of BC and the dismal outcome of secondary leukemias. Further studies are needed to determine the risk for other hematological malignancies, possible responsible agents, and mechanisms.

Pure mucinous carcinoma of the breast: a single center experience

PURPOSE

Mucinous breast carcinoma is rare subtype of breast cancer. Histopathologically, it is classified into two forms, pure and mixed type. It recurs late, metastasis to axillary lymph nodes is less common and is more hormone receptor positive. We herein present the data of our patients with pure mucinous breast cancer (PMBC) treated in our institution.

METHODS

Among 1211 breast cancer patients with breast cancer diagnosed and treated in Hacettepe University Institute of Oncology, 20 patients (1.6%) with PMBC (defined as having mucinous component of more than 90%) were identified. Patient demographics, tumor characteristics and patient outcomes were assessed retrospectively.

RESULTS

The median age at diagnosis was 52.5 years (range 27-80). The majority of the patients presented with stage II disease (n=15; 75%). One of 20 patients recurred with bone metastasis 50 months after diagnosis. Median follow-up was 39 months (range 3-137). Estrogen receptors (ER) were positive in 16 (80%) patients and HER-2 positive in one (5%). Twenty-five percent of the patients had positive axillary nodes.

CONCLUSION

PMBC is a rare entity with favorable prognosis. Lymph node metastasis is rarely seen even in large -sized tumors.

The Frequency and Determinants of Metabolic Syndrome in Patients with Operable Stage I-III Breast Cancer

Background: Metabolic syndrome is a cluster of multiple risk factors including obesity, insulin resistance, hypertriglyceridemia, low HDL (high density lipoprotein), and hypertension. Metabolic syndrome is associated with an increased risk of breast cancer. We evaluated the frequency and determinants of metabolic syndrome in patients with operable stage I-III breast cancer.Methods: In this cross-sectional study we analyzed the frequency and determinants of metabolic syndrome in patients with stage I-III breast cancer. Metabolic syndrome was defined according to NCEP (National Cholesterol Education Program) definitions. Data on metabolic syndrome criteria were collected along with demographic data, tumor size, grade, lymph node, estrogen, progesterone, HER2 status, grade and history of chemotherapy/endocrine therapy.Results: A total of 331 patients were analyzed. Median age was 50.0 years (range 20-84 years). Eighty-five patients were using tamoxifen, 98 patients were using aromatase inhibitors and the remaining 148 patients were not receiving hormonal therapy (newly diagnosed and/or triple-negative patients). According to the NCEP criteria 48.0% of the patients had metabolic syndrome. More patients receiving aromatase inhibitors had metabolic syndrome than those receiving tamoxifen (60.2% vs. 37.6%, p = 0.008). The frequency of MS among those not taking any hormonal therapy was 45.9%. Additionally, post-menopausal patients had higher rate of MS compared to pre-menopausal ones (53.4% vs. 25.0% p=&lt;0.001). Patients with HER2 positive tumors and patients who had a history of oral contraceptive use had lower rates of metabolic syndrome than those with HER2 negative tumors and no oral contraceptive use, respectively (40,0% vs. 53,7% for HER2, p=0.028 and 32,6% vs. 50,3% for oral contraceptive use, p=0.034).There was no significant correlation between the presence of metabolic syndrome and estrogen/progesterone receptor status, tumor size, nodal status, stage, grade, adjuvant chemotherapy, hormone replacement therapy, smoking history.Conclusions: Nearly half of the patients with stage I-III breast cancer had metabolic syndrome. Adjuvant aromatase inhibitor therapy was found to be associated with higher rate of metabolic syndrome whereas history of oral contraceptive use and HER2 positivity were associated with lower rate. Whether the aromatase inhibitors contribute the development of metabolic syndrome or not needs to be elucidated by future prospective studies.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 5121.

Performance of leaching bed reactor converting the organic fraction of municipal solid waste to organic acids and alcohols

A lab-scale leaching bed reactor (LBR) was operated to (1) investigate the potential of in-vessel solid-state anaerobic digestion of the organic fraction of municipal solid waste (MSW) and (2) examine the feasibility of using LBRs for hydrolysis/liquefaction and acidification of organic fraction of MSW for maximum total volatile fatty acid (tVFA) and alcohol production. A hydrolysis efficiency of 60% was achieved in the LBR, which was mainly affected by the solids content of organic fraction of MSW, the amount of water addition into the LBR and the channeling through the waste bed. The net mass of tVFA produced was 7000 mg at the end of 80 d. The main individual VFAs produced were acetic and butyric acids and the main alcohol was ethanol. The variations in the by-products of acidification were mainly due to the nature of feed and pH variations in the LBR. LBRs achieved rapid hydrolysis and acidification of organic fraction of MSW, consequently, high hydrolysis yield, chemical oxygen demand removal and tVFA production.