Ocular health screening among care-center residents with disabilities: a smartphone adaptive fundus camera cross-sectional study.

OBJECTIVE: The aim of this study was to evaluate the ocular health of care-center residents with disabilities who have difficulty accessing health care using a novel smartphone-adapted fundus camera device, and to compare the results to age- and gender-matched health subjects. PATIENTS AND METHODS: In this study, 47 care-center residents with disabilities were investigated between October 1, 2021, and December 31, 2021. A control group was made up of healthy volunteers. All participants underwent a comprehensive ocular exam, which included measuring visual acuity and assessing dry eye with Schirmer and tear break-up time tests. The posterior segment was examined using a smartphone-adapted fundus camera. The data gathered was compared with statistical significance between the two groups. RESULTS: The mean ages of disabled and healthy participants were 59.7±15.2 and 56.6±15.0 years, respectively (p=0.305). While 11.1% of the 36 visually impaired participants were legally blind, the percentage among healthy subjects was only 3.7% (p=0.168). In comparison to healthy participants, disabled people had statistically significantly higher rates of dry eye (27.7%), senile macular degeneration (23.4%), and cataracts (29.8%) (p<0.05). CONCLUSIONS: Screening for ocular health with a novel smartphone-adapted fundus camera revealed significantly higher rates of various ocular diseases in care center disabled residents. Given technological progress, remote control method-assisted ocular exams appear to be potentially feasible and clinically beneficial. This could allow trained allied health personnel to perform ocular health screenings without the need to transport a disabled person to the hospital. Thus, diagnosis and follow-up of various chronic ocular diseases may be properly organized.

Spontaneous recognition: Investigating the role of working memory.

In almost every aspect of life, focusing on a target and ignoring distractors effectively is very important. Alternative to the common view, distraction may aid recognition via triggering automatic responses. Spontaneous recognition (SR) can be defined as the unintentional recognition of target stimuli and is measured by the effect of familiarity to distractors on a recognition task. Research has indicated that previously seen or not seen (old/new) distractors affect the recognition of targets. This research aimed to investigate the influence of working memory load on SR. A dual-task was designed to ensure engagement in two tasks-namely, the memory Stroop task (recognition task) and the n-back task (working memory task) at the same time. This design enabled an investigation of the influence of working memory load and allowed for further exploration of the influence of episodic memory load and the characteristics of n-back task. The results are in line with previous research; participants were more accurate when target and distractor were congruent versus when they were incongruent, but only when WM load was high. This interaction was modulated by episodic memory load and n-back task trials (match/mismatch). It was concluded that many factors may contribute to the SR effect. This research demonstrated that the SR effect is determined by WM availability and recognition processes engaged in another task.

Successful treatment of aortic rupture with endovascular stent grafting in a patient with mantle cell lymphoma.

PURPOSE: To present a case of spontaneous aortic rupture in the course of mantle cell lymphoma and successful management with endovascular repair. CASE REPORT: A 69-year-old woman presented with a cervical mass. The patient was found to have stage IIIA and Mantle Cell Lymphoma International Prognostic Index (MIPI) 4. She was placed in an intermediate-risk group. The patient received an initial cycle of systemic chemotherapy consisting of rituximab, anthracycline, vincristine and methyl prednisolone. During follow-up, she developed abdominal aortic rupture secondary to intramural hematoma which was successfully managed with endovascular exclusion. CONCLUSION: Hemodynamic changes can be seen during the course of lymphoma subsequent to systemic chemotherapy. These changes might be related to the spontaneous rupture of the main vessels. Endovascular repair may be a more appropriate treatment option than open surgery, especially in a patient with multiple comorbidities.

Kaposi's Sarcoma following Chronic Lymphocytic Leukemia: A Rare Entity.

Cutaneous manifestations can occur in the wide range of internal malignancy. They can occur by metastases or local spread, direct infiltration, or a site of primary malignancy itself. Sometimes these manifestations are related with an underlying malignancy but they do not contain malignant cells as paraneoplastic dermatological syndromes. Chronic lymphocytic leukemia (CLL) is the most common leukemia all over the world. Cutaneous lesions occur in up to 25% of patients. Most commonly seen cutaneous lesions in CLL are those of infectious or hemorrhagic origin. Skin cancer risk was also increased eightfold in CLL when compared with normal population, so cutaneous lesions in CLL can be the first manifestation of secondary skin malignancy. Herein, we report an interesting case of Kaposi's sarcoma which was diagnosed during the course of CLL.

Patients with advanced cholangiocarcinoma benefit from chemotherapy if they are fit to receive it: single center experience.

PURPOSE: The purpose of this study was to report the clinical course and outcome of patients suffering from advanced cholangiocarcinoma (CCA). METHODS: The medical records of 93 patients with unresectable or metastatic CCA were retrospectively analyzed. RESULTS: Out of 93 patients, 53 (64.9%) were initially managed with palliative biliary drainage (PBD). Cisplatinbased regimens were administered to 18 (19.3%) patients, and non-cisplatin regimens (mainly 5-fluorouracil [5-FU]- based) were administered to 23 (24.8%) patients. Of all 93 patients 53 (55.9%) did not receive chemotherapy. The median overall survival (OS) for all patients was 6.1 months and was significantly higher in patients treated with chemotherapy as compared to those without chemotherapy (p=0.002). However, no difference in OS was seen in patients treated with cisplatin- or 5-FU-based chemotherapy. We noticed that a high number of patients were not referred to a medical oncologist even for advice. CONCLUSION: The relief of bile duct obstruction is an important part of the initial patient management. One of the main observations of this study was that systemic chemotherapy significantly improved survival. Increased awareness of the medical oncologists' role in the management of CCA can increase the number of patients who can have access to chemotherapy.

Vaginal high dose rate brachytherapy alone in patients with intermediate- to high-risk stage I endometrial carcinoma after radical surgery.

The objective of this study was to analyze the efficacy and morbidity of vaginal cuff brachytherapy alone in intermediate- to high-risk stage I endometrial cancer patients after complete surgical staging. Between October 1994 and November 2005, 128 patients with intermediate- to high-risk stage I endometrial adenocarcinoma were treated with high dose rate (HDR) brachytherapy alone after complete surgical staging. The intermediate- to high-risk group was defined as any stage I with grade 3 histology or stage IB grade 2 or any stage IC disease. The comprehensive surgery was in the form of total abdominal hysterectomy, bilateral salpingo-oophorectomy in addition to infracolic omentectomy, and routine pelvic and para-aortic lymphadenectomy. The median number of the lymph nodes dissected was 33. The median age at the time of diagnosis was 60 years. Forty patients were staged as IB (grade 2: 25 and grade 3: 15), and 88 patients were staged as IC (grade 1: 31, grade 2: 41, and grade 3: 16). A total dose of 27.5 Gy with HDR brachytherapy, prescribed at 0.5 cm, was delivered in five fractions in 5 consecutive days. Median follow-up was 48 months. Six (4.7%) patients developed either local recurrence (n = 2) or distant metastases (n = 4). Five-year overall survival and disease-free survival (DFS) rates are 96% and 93%, respectively. Only age was found to be significant prognostic factor for DFS. Patients younger than 60 years have significantly higher DFS (P = 0.006). None of the patients experienced grade 3/4 complications due to the vaginal HDR brachytherapy. Vaginal cuff brachytherapy alone is an adequate treatment modality in stage I endometrial adenocarcinoma patients with intermediate- to high-risk features after complete surgical staging with low complication rates.

Colon adenocarcinoma and solitary tibia metastasis: rare entity.

INTRODUCTION: Colorectal cancer is the third leading cause of cancer-related deaths in the world. Mostly, death occurs with complications of distant metastases. DISCUSSION: Effective systemic chemotherapy regimen and resultant improved survival for patients are associated with an increased incidence of metastases at uncommon sites. Therefore, incidences of osseous metastases are rising at the last decade. Osseous metastases are mostly diffuse, along with visceral metastases. CONCLUSION: Most common osseous metastatic sites are lumbal, sacral vertebrae, and pelvis region, probably because of colonic anatomical proximity to the paravertebral venous plexus. Herein, we report an uncommon case of isolated solitary tibia metastasis in the colorectal cancer patient and management of disease course.

Long-term outcome and prognostic factors in patients with cervical carcinoma: a retrospective study.

This study evaluates treatment outcomes and possible prognostic factors of inoperable cervical cancer patients treated with external beam radiotherapy (EBRT) and high-dose rate brachytherapy (HDR BRT). Between 1993 and 2000, 183 patients with cervical cancer were treated at our institute. Radiotherapy was the sole treatment modality until January 1997; after the announcement of National Cancer Institute in 1999, 40 mg/m(2) of cisplatin (49%) was routinely applied every week. Median age was 54 years (32-92 years). Most patients (88%) had advanced-stage disease (IIB-IIIB). With a median follow-up time of 45 months (6-121 months), the 5-year overall survival (OS), local recurrence-free survival, disease-free survival (DFS), and distant metastasis-free survival (DMFS) rates were 55%, 71%, 51%, and 77%, respectively. Univariate analysis revealed that age, tumor size, lymph node status, and concomitant cisplatin were prognostic factors for OS. The DFS rates were lower in young age group. Patients with tumor greater than 4 cm and age greater than 40 were at greater risk for local recurrence. Distant metastases were more frequent in patients with adenocarcinoma. Concurrent cisplatin use increases DMFS rates (91% vs 78%; P= 0.05). In multivariate analysis, extensive stage, parametrial infiltration, young age, adenocarcinoma histopathology, and lymph node metastasis were negative prognostic factors for OS while concomitant cisplatin increases OS. Likewise, patients with extensive stage, adenocarcinoma, and without concurrent cisplatin administration had more risk for distant metastasis. There was no treatment-related mortality. Grade 3-4 morbidity rates were seen only in eight patients (4%). The combination of EBRT and HDR BRT together with concomitant chemotherapy in the treatment of locally advanced carcinoma of cervix is safe and well tolerated with acceptable morbidity.

Correlation of serum and ascitic IL-12 levels with second-look laparotomy results and disease progression in advanced epithelial ovarian cancer patients.

Forty-two consecutive patients with advanced epithelial ovarian cancer who underwent primary surgical treatment were evaluated. The control group comprised 21 patients who had undergone surgery associated with benign pathologies. Forty-one patients had stage III disease except one who had stage IV. Optimal debulking (<1 cm) was performed in all the patients who subsequently received chemotherapy. Based on the results of the second-look laparotomy and follow-up, the patients were divided into three groups: the first group had negative second-look laparotomy or no evidence of disease during follow-up (n= 21), the second group had positive second-look laparotomy or progressive disease (n= 21), and the third was the control group (n= 21). Interleukin-12 (IL-12) levels were measured in preoperative serum and intraoperative ascites samples for all the patients. The mean serum IL-12 levels (+/-SD) in serum (S) and ascites (A) were as follows: in the first group, S: 108.44 +/- 76.40 pg/mL and A: 330.93 +/- 125.25 pg/mL; in the second group, S: 51.80 +/- 40.95 pg/mL and A: 206.89 +/- 113.47 pg/mL; and in the control group, S: 36.55 +/- 33.16 pg/mL and A: 93.62 +/- 73.07 pg/mL (P= 0.01). In the patients with advanced ovarian cancer, IL-12 levels in serum and ascites were higher compared to the levels of the controls. Also, there was an inverse relationship between initial serum and ascitic IL-12 levels and disease progression.

Radical versus conservative surgery for vulvar carcinoma.

OBJECTIVE: The comparison of the radical and conservative surgical approaches for vulvar carcinoma in relation to the rate of recurrence and complications. METHODS: The records of invasive vulvar carcinoma cases were retrospectively reviewed in Istanbul University, Cerrahpasa School of Medicine, Gynecologic Oncology Division and Social Insurance Institution, Ankara Maternity Hospital, Gynecologic Oncology Department. Surgically treated cases with squamous histology were divided into radical vulvectomy and conservative procedures groups and were compared with respect to recurrence, complications, and disease-free survival. RESULTS: One hundred thirteen cases of invasive vulvar carcinoma cases were of squamous histopathology and 92 of these were surgically treated. The rate of local recurrence was lower in the radical vulvectomy group (25%) compared to conservative procedures groups (42.5%; p>0.05). The complication rates were comparable between the radical vulvectomy and conservative procedures groups (32.7% versus 35%, respectively; p>0.05). At the end of five years of the follow-up, the disease-free survival rates were 51.5% in radical vulvectomy group versus 35.7% in conservative procedures group (p>0.05). CONCLUSION: The rate of recurrence, complication, and disease-free survival are similar for the radical vulvectomy and the conservative procedures. Deciding the surgical strategy for vulvar carcinoma should depend on the experience of the surgeon for the short-term adequate results.

Coincidental detection of T-cell rich B cell lymphoma in the para-aortic lymph nodes of a woman undergoing lymph node dissection for cervical cancer: a case report.

The diagnosis of cervical squamous cell carcinoma with concurrent T-cell rich B cell lymphoma in dissected lymph nodes has not been reported to our knowledge. In our case, the biopsy of an exophytic lesion at the uterine cervix showed squamous cell carcinoma in a 50-year-old woman presenting with postcoital bleeding. Type III hysterectomy, bilateral salpingo-oophorectemy, bilateral pelvic, para-aortic lymph node dissections were performed. Pathologic examination revealed a T-cell rich B cell lymphoma in some lymph nodes beside squamous cell carcinoma in several of others. ELISA for human immuno-deficiency virus (HIV) was negative. The cervical carcinoma was staged as FIGO clinical stage IB1 and the lymphoma as Ann Arbor IIA. Six cycles of CHOP (cyclophosphamide, adriamycin, vincristine, and prednisolon) chemotherapy for the lymphoma and concomitant pelvic chemoradiotherapy with cisplatin for cervical cancer were given. In this rare coincidence, the best available therapy for each of the diseases should be considered individually. We also suggest that HIV screennig test be carried out, because both diseases may be related to human immuno-deficiency virus, although our patient is HIV-negative.

Coincidental detection of T-cell rich B-cell lymphoma in the paraaortic lymph nodes of a woman undergoing lymph node dissection for cervical cancer.

The diagnosis of cervical squamous cell carcinoma with concurrent T-cell rich B-cell lymphoma in dissected lymph nodes has not been reported to our knowledge. We report such a case. The biopsy of an exophytic lesion at the uterine cervix showed squamous cell carcinoma in a 50-year-old woman presenting with postcoital bleeding. Type III hysterectomy, bilateral salpingo-oophorectemy, bilateral pelvic, paraaortic lymph node dissections were performed. Pathologic examination revealed a T-cell rich B-cell lymphoma in some lymph nodes beside squamous cell carcinoma in several of others. ELISA for human immuno-deficiency virus (HIV) was negative. The cervical carcinoma was staged as FIGO clinical stage IB1 and the lymphoma as Ann Arbor IIA. Six cycles of CHOP (cyclophosphamide, adriamycin, vincristine, and prednisone) chemotherapy for the lymphoma and concomitant pelvic chemo-radiotherapy with cisplatin for cervical cancer were given. In this rare coincidence; the best available therapy for each of the diseases should be considered individually. We also suggest that HIV screening test be carried out, because both diseases may be related to human immuno-deficiency virus, although our patient was HIV-negative.

Visualizing plant metabolomic correlation networks using clique-metabolite matrices.

MOTIVATION: Today, metabolite levels in biological samples can be determined using multiparallel, fast, and precise metabolomic approaches. Correlations between the levels of various metabolites can be searched to gain information about metabolic links. Such correlations are the net result of direct enzymatic conversions and of indirect cellular regulation over transcriptional or biochemical processes. In order to visualize metabolic networks derived from correlation lists graphically, each metabolite pair may be represented as vertices connected by an edge. However, graph complexity rapidly increases with the number of edges and vertices. To gain structural information from metabolite correlation networks, improvements in clarity are needed. RESULTS: To achieve this clarity, three algorithms are combined. First, a list of linear metabolite correlations is generated that can be regarded as a set of pairs of edges (or as 2-cliques). Next, a branch-and-bound algorithm was developed to find all maximal cliques by combining submaximal cliques. Due to a clique assignment procedure, the generation of unnecessary submaximal cliques is avoided in order to maintain high efficiency. Differences and similarities to the Bron-Kerbosch algorithm are pointed out. Lastly, metabolite correlation networks are visualized by clique-metabolite matrices that are sorted to minimize the length of lines that connect different cliques and metabolites. Examples of biochemical hypotheses are given that can be built from interpretation of such clique matrices. AVAILABILITY: The algorithms are implemented in Visual Basic and can be downloaded from our web site along with a test data set (http://www.mpimp-golm.mpg.de/fiehn/projekte/data-mining-e.html). CONTACT: kose@mpimp-golm.mpg.de