Prognostic factors of breast cancer brain metastasis

In this editorial we comment on the article by Chen et al published in the recent issue of the World Journal of Clinical Oncology.Brain metastasis is one of the most serious complications of breast cancer and causes high morbidity and mortality.Brain metastases may involve the brain parenchyma and/or leptomeninges.Symptomatic brain metastases develop in 10%-16%of newly recognized cases each year,and this rate increases to 30%in autopsy series.Depending on the size of the metastatic foci,it may be accompanied by extensive vasogenic edema or may occur as small tumor foci.Since brain metastases are a significant cause of morbidity and mortality,early diagnosis can have significant effects on survival and quality of life.The risk of developing brain metastases emerges progressively due to various patient and tumor characteristics.Patient variability may be particularly important in the susceptibility and distribution of brain metastases because malignant blood must cross the brain barrier and move within the brain parenchyma.Some characteristics of the tumor,such as gene expression,may increase the risk of brain metastasis.Clinical growth,tumor stage,tumor grade,growth receptor positivity,HER2 positivity,molecular subtype(such as triple negative status,luminal/nonluminal feature)increase the risk of developing breast cancer metastasis.Factors related to survival due to breast cancer brain metastasis include both tumor/patient characteristics and treatment characteristics,such as patient age,lung metastasis,surgery for brain metastasis,and HER2 positivity.If cases with a high risk of developing brain metastasis can be identified with the help of clinical procedures and artificial intelligence,survival and quality of life can be increased with early diagnosis and treatment.At the same time,it is important to predict the formation of this group in order to develop new treatment methods in cases with low survival expectancy with brain metastases.

Circulating tumor cells as prognostic marker in pancreatic cancer

In this editorial we comment on the article by Zhang et al published in the recent issue of the World Journal of Clinical Oncology.Pancreatic cancer is the fourth most common cause of cancer-related mortality and has the lowest survival rate among all solid cancers.It causes 227000 deaths annually worldwide,and the 5-year survival rate is very low due to early metastasis,which is 4.6%.Cancer survival increases with better knowledge of risk factors and early and accurate diagnosis.Circulating tumor cells(CTCs)are tumor cells that intravasate from the primary tumor or metastasis foci into the peripheral blood circulation system spontan-eously or during surgical operations.Detection of CTC in blood is promising for early diagnosis.In addition,studies have associated high CTC levels with a more advanced stage,and more intensive treatments should be considered in cases with high CTC.In tumors that are considered radiologically resectable,it may be of critical importance in detecting occult metastases and preventing unnecessary surgeries.

Evaluation of ischemic lesions after carotid artery stenting with diffusion-weighted imaging

BACKGROUND Almost 90%of cerebral thromboembolism cases are caused by atherosclerosis.Craniocervical atherosclerosis is often observed at the carotid bifurcation and is responsible for 20%-30%of all stroke cases.The course of atherosclerotic carotid artery stenosis varies depending on the grade of stenosis and characteristics of the plaque.Carotid artery stenting(CAS)can be used as a less invasive method in patients with symptomatic and asymptomatic high-grade carotid artery stenosis.Diffusion-weighted imaging(DWI)is an effective method for detection of silent or symptomatic acute ischemic lesions that may arise due to CAS or carotid endarterectomy.The number and volume of new ischemic lesions are determined using DWI.AIM To evaluate the number and volume of ischemic lesions and their cerebral parenchymal and vascular distribution after CAS using DWI.METHODS Forty-seven male(73.4%)and seventeen female(26.6%)patients(total,n=64)aged 42-84 years(mean 67.96±8.03 years)diagnosed with carotid stenosis between October 2006 and July 2012 were included in this retrospective study.Twelve of the cases(18.8%)were asymptomatic,while fifty-two(81.2%)were symptomatic.The area where the stenosis was highest was measured,and the stenosis rate was determined using the North American Symptomatic Carotid Endarterectomy Trial method.DWI of the cases was evaluated by two radiologists experienced in neuroradiology(B.A.with more than 15 years of experience,E.G.with more than 10 years of experience).Routine DWI examinations were carried out by a 1.5 T MR device 1 h before and after the operation.Since the ischemic lesions that developed in the first hour and in the follow-up period of 5-24 h were assumed to be due to CAS,all lesions within the first 24 h were considered as new ischemias.RESULTS In the present study,39 new ischemic lesions were detected in 20 cases.The average number of new lesions after all CAS operations was 0.62.They were mostly located in the occipital lobes,followed by the frontal and parietal lobes.These new ischemic lesions were most common in the middle cerebral artery territory,followed by the posterior cerebral artery territory and middle cerebral artery-posterior cerebral artery watershed areas.New lesions were found in 31.2%(20/64)of patients,including 17(26.5%)in ipsilateral and three(4.6%)in contralateral hemispheres.New bilateral lesions were detected in one case(1.5%).The average volume of the new ischemic lesions detected by the two observers was 1.10 cm³.The numbers of newly appearing ischemic lesions in DWI after CAS were significantly higher in cases where stenting was applied on the left side of the carotid artery and in cases where longer plaques(>1 cm)were responsible for the narrowing in symptomatic patients.The stenosis rate was low in the group with ulcerated plaques.CONCLUSION New ischemic lesions due to CAS appear mostly in the main arterial territory but they may also occur in watershed areas.

Small cell carcinoma of rectum: A case report

We present a case of a 40-year-old woman with smallcell carcinoma (SCC) of the rectum. She had profuse bleeding in rectum for 5 d. By colonoscopy, polyps were determined in the rectum and biopsies were carried out.Histopathologically, the polyps were adenomatous. Because of the profuse bleeding in rectum, she underwent low anterior resection. After the diagnosis of SCC, she received intravenous chemotherapy with standard doses of siklofosfamid, adriamycin, and vepesid. Nevertheless,intracranial metastases were revealed and she died 6 mo after the operation.

Surgical Method for Facilitation of Aortic Valve Replacement:Intraoperative Application of External Pressure for Increasing the Transverse Axis of Aortic Annulus

Background: Surgical method was introduced for enhancement of prosthetic valve insertion and overcoming difficulties ensourcing from prosthesis-patient mismatch. Methods: Twenty-two patients that underwent aortic valve replacement between January 2005 and July 2009 were included in this prospective study. In these patients, the insertion of prosthesis larger than the annulus diameter was attempted after the application of an external pressure that increased the transverse axis diameter of the aortic annulus. The postoperative results and complications were assessed. Results: This surgical method was performed on 22 patients (16 males, 6 females, mean age: 52.2 ± 15.8 years) during the valve replacement. In 12 patients (55%), replacement of proper sized aortic valve compliant to their surface area was accomplished, while the insertion of a proper valve could not be achieved in 10 (45%) of the patients. No perioperative mortality or complications related to the procedure were reported. Conclusion: Increasing the transverse diameter of aortic valve may not only facilitate the insertion of a prosthetic valve but also aid in overcoming prosthesis-patient mismatch. Further studies on larger series are necessary to document the actual effectively and precise selection criteria for application of this method.

Endoscopic ear surgery

Objectives:This article reviews the advantages and disadvantages of endoscopic ear surgery(EES).Method:Pubmed,Google and the Proquest Central Database at Kirikkale University were queried using the keywords"endoscopic ear surgery","ear surgery"and"endoscopy"to identify the literature needed for the review.Results:Endoscopes allow for enhanced surgical visualisation.The distal part of the apparatus is illuminated and contains lenses angled to allow a wider view of the operative area.Transcanal endoscopic techniques have transformed the external ear canal(EAC)into an operative gateway.The benefits EES can offer include wider views,enhanced imaging capabilities and increased magnification,and ways to see otherwise poorly visualisable portions of the middle ear.EES permits surgeons to operate using minimally invasive otological techniques.When compared with microscope-assisted surgery,endoscopic tympanoplasty has been shown to require a shorter operating time in some instances.There are a number of drawbacks to EES,however,which include the fact that it is a single-handed technique,that the light source may produce thermal injury and that visualisation using the endoscope is severely curtailed if bleeding is profuse.Conclusion:EES is a safe and effective technique.The current literature supports the idea that the results achieved by endoscopic methods are usually comparably beneficial to results obtained using conventional microscopic methods.

子宫内膜息肉的发生部位、直径大小及数量是否与其症状学有关

Objective: The objective of the study was to evaluate the relationship among polyp site, number, diameter, and symptomatology in endometrial polyps in reproductive and postmenopausal women. Study design: One hundred fifty-five subjects with endometrial polyps were evaluated retrospectively. Sociodemographic characteristics, endometrial thickness, polyp number, diameter, and site were reviewed, and their relations with abnormal uterine bleeding were tested. Results: A total of 36.1% of the patients in the postmenopausal group and 44.4% of the patients in the reproductive-aged group were asymptomatic. In addition, 37.3% of polyps in the reproductive-aged and 29.2% in the postmenopausal group were multiple. Polyp number, diameter, and site were not different among the 2 groups (P = .282, P = .469, and P = .485, respectively). When patients were evaluated as a whole, symptomatology was not related with polyp number, diameter, and site (P = .677, P = .334, and P = .699, respectively). Conclusion: Many endometrial polyps are asymptomatic and multiple in nature. Polyp site, number, and diameter do not correlate with symptomatology.

多毛症评分系统应具有人群特异性

The aim of our study was to evaluate severity of hirsutism, assessed via the Ferriman-Gallwey scoring system in 12 different androgen-sensitive skin areas among 65 consecutive hirsute patients with functional androgen excess (polycystic ovary syndrome and idiopathic hirsutism) from the Central Anatolian region of Turkey. Results of this descriptive study showed that the buttocks/perineum, sideburn, and neck areas greatly contributed to the total hirsutism score, rather than the upper arm, upper back, and upper abdomen.

Artificial intelligence in radiation oncology

Artificial intelligence(AI)is a computer science that tries to mimic human-like intelligence in machines that use computer software and algorithms to perform specific tasks without direct human input.Machine learning(ML)is a subunit of AI that uses data-driven algorithms that learn to imitate human behavior based on a previous example or experience.Deep learning is an ML technique that uses deep neural networks to create a model.The growth and sharing of data,increasing computing power,and developments in AI have initiated a transformation in healthcare.Advances in radiation oncology have produced a significant amount of data that must be integrated with computed tomography imaging,dosimetry,and imaging performed before each fraction.Of the many algorithms used in radiation oncology,has advantages and limitations with different computational power requirements.The aim of this review is to summarize the radiotherapy(RT)process in workflow order by identifying specific areas in which quality and efficiency can be improved by ML.The RT stage is divided into seven stages:patient evaluation,simulation,contouring,planning,quality control,treatment application,and patient follow-up.A systematic evaluation of the applicability,limitations,and advantages of AI algorithms has been done for each stage.

Artificial intelligence in rectal cancer

Accurate and rapid diagnosis is essential for correct treatment in rectal cancer.Determining the optimal treatment plan for a patient with rectal cancer is a complex process,and the oncological results and toxicity are not the same in every patient with the same treatment at the same stage.In recent years,the increasing interest in artificial intelligence in all fields of science has also led to the development of innovative tools in oncology.Artificial intelligence studies have increased in many steps from diagnosis to follow-up in rectal cancer.It is thought that artificial intelligence will provide convenience in many ways from personalized treatment to reducing the workload of the physician.Prediction algorithms can be standardized by sharing data between centers,diversifying data,and creating big data.