Determinants of Opioid Efficiency in Cancer Pain: a Comprehensive Multivariate Analysis from a Tertiary Cancer Centre

Goksu, Sema Sezgin,Bozcuk, Hakan,Uysal, Mukremin,Ulukal, Ece,Ay, Seren,Karasu, Gaye,Soydas, Turker,Coskun, Hasan Senol,Ozdogan, Mustafa,Savas, Burhan Asian Pacific Journal of Cancer Prevention 2014 Asian Pacific journal of cancer prevention Vol.15 No.21

Background: Pain is one of the most terrifying symptoms for cancer patients. Although most patients with cancer pain need opioids, complete relief of pain is hard to achieve. This study investigated the factors influencing persistent pain-free survival (PPFS) and opioid efficiency. Materials and Methods: A prospective study was conducted on 100 patients with cancer pain, hospitalized at the medical oncology clinic of Akdeniz University. Patient records were collected including patient demographics, the disease, treatment characteristics, and details of opioid usage. Pain intensity was measured using a patient self-reported visual analogue scale (VAS). The area under the curve (AUC) reflecting the pain load was calculated from daily VAS tables. PPFS, the primary measure of opioid efficacy, was described as the duration for which a patient reported a greater than or equal to two-point decline in their VAS for pain. Predictors of opioid efficacy were analysed using a multivariate analysis. Results: In the multivariate analysis, PPFS was associated with the AUC for pain (Exp (B)=0.39 (0.23-0.67), P=0.001), the cumulative opioid dosage used during hospitalisation (Exp (B)=1.00(0.99-1.00), P=0.003) and changes in the opioid dosage (Exp (B)=1.01 (1.00-1.01), P=0.016). The change in VAS score over the standard dosage of opioids was strongly associated with current cancer treatment (chemotherapy vs. others) (${\beta}=-0.31$, T=-2.81, P=0.007) and the VAS for pain at the time of hospitalisation (${\beta}=-0.34$, T=-3.07, P= 0.003). Conclusions: The pain load, opioid dosage, concurrent usage of chemotherapy and initial pain intensity correlate with the benefit received from opioids in cancer patients.

Use of Blood Transfusion at the End of Life: Does it Have Any Effects on Survival of Cancer Patients?

Goksu, Sema Sezgin,Gunduz, Seyda,Unal, Dilek,Uysal, Mukremin,Arslan, Deniz,Tatli, Ali Murat,Bozcuk, Hakan,Ozdogan, Mustafa,Coskun, Hasan Senol Asian Pacific Journal of Cancer Prevention 2014 Asian Pacific journal of cancer prevention Vol.15 No.10

Background: Treatment of anemia is an important issue in the palliative care setting. Blood transfusion is generally used for this purpose in supportive care. However the place of blood transfusion in terminally ill cancer cases is less far established. Objective: We aimed to outline the use of transfusions and to find the impact of blood transfusion on survival in patients with advanced cancer and very near to death. Design: Patients dying in 2010-2011 with advanced cancer were included in the study. We retrospectively collected the data including age, type of cancer, the duration of last hospitalisation, ECOG performance status, Hb levels, transfusion history of erythrocytes and platelets, cause and the amount of transfusion. The anaemic patients who had transfusion at admission were compared with the group who were not transfused. Survival was defined as the time between the admission of last hospitalisation period and death. Results: Three hundred and ninety eight people with solid tumours died in 2010-2011 in our clinic. Ninety percent of the patients had anemia at the time of last hospitalisation. One hundred fifty three patients had erythrocyte transfusion at admission during the last hospitalisation period (38.4%). In the anaemic population the duration of last hospitalisation was longer in patients who had erythrocyte transfusion (15 days vs 8 days, p<0.001). Conclusions: Patients who had blood transfusion at the end of life lived significantly longer than the anaemic patients who were not transfused. This study remarks that blood transfusions should not be withheld from terminal cancer patients in palliative care.

Clinicopathologic Features and Molecular Subtypes of Breast Cancer in Young Women (Age ≤35)

Goksu, Sema Sezgin,Tastekin, Didem,Arslan, Deniz,Gunduz, Seyda,Tatli, Ali Murat,Unal, Dilek,Salim, Derya,Guler, Tunc,Coskun, Hasan Senol Asian Pacific Journal of Cancer Prevention 2014 Asian Pacific journal of cancer prevention Vol.15 No.16

Introduction: Breast cancer in young women is a relatively rare disease; however it tends to be more aggressive and is the leading cause of cancer death in this population. The aim of this study is to investigate the clinical and biological features of breast cancer arising in young Turkish breast cancer patients. Materials and Methods: Patients with breast cancer aged 35 or less (${\leq}35$ years) were selected for the study. In total 211 cases were included. Pathologic features; histologic subtypes, grade, lymphovascular invasion, axillary involvement, and stage were recorded for each. Results: The most common subtype was luminal B (36.5%), followed by luminal A (30.8%), triple negative (23.2%) and HER2+(9.5%) subtypes. Twelve percent of the patients had stage 4, 32.7% had stage 3, 46.4% had stage 2, and 6.2% had stage 1 disease at the time of diagnosis. Mean tumour diameter was 3.87 cm (range 0.3-13 cm). The axillary lymph nodes were positive in 74.4% of the patients, while lympho-vascular invasion was seen in 56.4%. Some 9.5% of patients had grade 1, 51.2% had grade 2, and 31.8% had grade 3 tumors. Conclusions: Young women with breast cancer in Turkey are more likely to present with luminal B subtype. Tumors in young women are more likely to present with advanced disease, to be high grade and and to have more lymphovascular invasion. Further research should focus on whether we need new treatment strategies for young patients with breast carcinoma.

Structural performance of recycled aggregates concrete sourced from low strength concrete

Caglar Goksu,Ilyas Saribas,Ergun Binbir,Yılmaz Akkaya,Alper Ilki 국제구조공학회 2019 Structural Engineering and Mechanics, An Int'l Jou Vol.69 No.1

Although much research has been carried out using recycled aggregates sourced from normal strength concrete, most of the buildings to be demolished are constructed with low strength concrete. Therefore, the properties of the concrete incorporating recycled aggregates, sourced from the waste of structural elements cast with low strength concrete, were investigated in this study. Four different concrete mixtures were designed incorporating natural and recycled aggregates with and without fly ash. The results of the mechanical and durability tests of the concrete mixtures are presented. Additionally, full-scale one-way reinforced concrete slabs were cast, using these concrete mixtures, and subjected to bending test. The feasibility of using conventional reinforced concrete theory for the slabs made with structural concrete incorporating recycled aggregates was investigated.

Controlled enzymatic stability and release characteristics of supramolecular chiral peptide amphiphile nanofiber gels

Aygul Zengin,Goksu Cinar,Mustafa O. Guler 한국물리학회 2017 Current Applied Physics Vol.17 No.5

Supramolecular bioarchitectures formed by assembly of achiral or chiral building blocks play important roles in various biochemical processes. Stereochemistry of amino acids is important for structural organization of peptide and protein assemblies and structure-microenvironment interactions. In this study, oppositely charged peptide amphiphile (PA) molecules with L-, D- and mixture of L- and D-amino acid conformations are coassembled into supramolecular nanofibers and formed self-supporting gels at pH 7.4 in water. The enzymatic stability of the PA nanofiber gels was studied in the presence of proteinase K enzyme, which digest a broad spectrum of proteins and peptides. The structural changes on the chiral PA nanofibers were also analyzed at different time periods in the presence of enzymatic activity. Controlled release of a model cargo molecule through the chiral PA nanofiber gels was monitored. The diffusivity parameters were measured for all gel systems. Release characteristics and the enzymatic stability of the peptide nanofiber gels were modulated depending on organization of the chiral PA molecules within the supramolecular assemblies.

Perimortem Cesarean Delivery Following Severe Maternal Penetrating Injury

Cuma Yildirim,Sitki Goksu,Hasan Kocoglu,Ahmet Gocmen,Melek Akdogan,Nurullah Gunay 연세대학교의과대학 2004 Yonsei medical journal Vol.45 No.SUP

The case of a severely traumatized pregnant patient, in whom a perimortem cesarean section, in the emergency department, led to the birth of a viable baby, with long-term survivor, is described. A postmortem cesarean section, resulting in fetal survival, performed after 45 minutes of maternal cardiopulmonary resuscitation is reported in a patient with multiple penetrating injuries. A 27-year-old primigravida suffered cardiopulmonary arrest at the 34th week of gestation following multiple knife injuries. Although extensive advanced cardiopulmonary resuscitation was performed for 45 minutes, her vital signs did not return to normal levels. A low segment cesarean delivery was performed, and a female baby was delivered. The time interval between cardiopulmonary arrest and delivery, prior maternal health status, and continued cardiopulmonary resuscitation are important determinants of fetal survival. A perimortem cesarean section is advised in case of multiple penetrating injuries, even after 45 minutes of cardiopulmonary resuscitation, since it may result in fetal salvage.

Assessment of seismic demand and damping of a reinforced concrete building after CFRP jacketing of columns

Pinar Inci,Caglar Goksu,Erkan Tore,Ergun Binbir,Ali Osman Ates,Alper Ilki 국제구조공학회 2022 Structural Engineering and Mechanics, An Int'l Jou Vol.82 No.5

While the lateral confinement provided by an FRP jacket to a concrete column is passive in nature, confinement is activated when the concrete expands due to additional compression stresses or significant shear deformations. This characteristic of FRP jacketing theoretically leads to similar initial stiffness properties of FRP retrofitted buildings as the buildings without retrofit. In the current study, to validate this theoretical assumption, the initial stiffness characteristics, and thus, the potential seismic demands were investigated through forced vibration tests on two identical full-scale substandard reinforced concrete buildings with or without FRP retrofit. Power spectral density functions obtained using the acceleration response data captured through forced vibration tests were used to estimate the modal characteristics of these buildings. The test results clearly showed that the natural frequencies and the mode shapes of the buildings are quite similar. Since the seismic demand is controlled by the fundamental vibration modes, it is confirmed using vibration-based full-scale tests that the seismic demands of RC buildings remain unchanged after CFRP jacketing of columns. Furthermore, the damping characteristics were also found similar for both structures.

Oral Cyclophosphamide and Etoposide in Treatment of Malignant Pleural Mesothelioma

Gunduz, Seyda,Mutlu, Hasan,Goksu, Sema Sezgin,Arslan, Deniz,Tatli, Ali Murat,Uysal, Mukremin,Coskun, Hasan Senol,Bozcuk, Hakan,Ozdogan, Mustafa,Savas, Burhan Asian Pacific Journal of Cancer Prevention 2014 Asian Pacific journal of cancer prevention Vol.15 No.20

Background: Malignant mesothelioma (MM) is almost always fatal and few treatment options are available. The aim of this study was to evaluate the efficacy of oral cyclophosphamide and etoposide for patients who underwent standard treatment for advanced MM. Materials and Methods: This study included 22 malignant pleural mesothelioma patients who were treated with oral cyclophosphamide and etoposide (EE). Results: The average follow-up period of the patients was 39.1 months. Under the treatment of oral EE, median progression-free survival was 7.7 months [95%CI HR (4.3-11.1)] and median overall survival was 28.1 months [95%CI HR (5.8-50.3)]. The treatment response rates were as follows: 4 patients (27.3%) had a partial response (PR), 12 (54.5%) had stable disease (SD), and progressive disease (PD) was observed in 6 (35.9%). Conclusions: Oral EE can be administered effectively to patients with inoperable malignant mesothelioma who had previously received standard treatments.

NLRC4 Inflammasome-Mediated Regulation of Eosinophilic Functions

Akkaya Ilgin,Oylumlu Ece,Ozel Irem,Uzel Goksu,Durmus Lubeyne,Ciraci Ceren 대한면역학회 2021 Immune Network Vol.21 No.6

Eosinophils play critical roles in the maintenance of homeostasis in innate and adaptive immunity. Although primarily known for their roles in parasitic infections and the development of Th2 cell responses, eosinophils also play complex roles in other immune responses ranging from anti-inflammation to defense against viral and bacterial infections. However, the contributions of pattern recognition receptors in general, and NOD-like receptors (NLRs) in particular, to eosinophil involvement in these immune responses remain relatively underappreciated. Our in vivo studies demonstrated that NLRC4 deficient mice had a decreased number of eosinophils and impaired Th2 responses after induction of an allergic airway disease model. Our in vitro data, utilizing human eosinophilic EoL-1 cells, suggested that TLR2 induction markedly induced pro-inflammatory responses and inflammasome forming NLRC4 and NLRP3. Moreover, activation by their specific ligands resulted in caspase-1 cleavage and mature IL-1β secretion. Interestingly, Th2 responses such as secretion of IL-5 and IL-13 decreased after transfection of EoL-1 cells with short interfering RNAs targeting human NLRC4. Specific induction of NLRC4 with PAM3CSK4 and flagellin upregulated the expression of IL-5 receptor and expression of Fc epsilon receptors (FcεR1α, FcεR2). Strikingly, activation of the NLRC4 inflammasome also promoted expression of the costimulatory receptor CD80 as well as expression of immunoregulatory receptors PD-L1 and Siglec-8. Concomitant with NLRC4 upregulation, we found an increase in expression and activation of matrix metalloproteinase (MMP)-9, but not MMP-2. Collectively, our results present new potential roles of NLRC4 in mediating a variety of eosinopilic functions.

Solutions of fractional order time-varying linear dynamical systems using the residual power series method

Sadeq Taha Abdulazeez,Mahmut MODANLI,Habibe GOKSU 호남수학회 2023 호남수학학술지 Vol.45 No.4

In this paper, the fractional order time-varying linear dynamical systems are investigated by using a residual power series method. A residual power series method (RPSM) is constructed for this problem. The exact solution is obtained by the Laplace transform method and the analytical solution is calculated via the residual power series method (RPSM). As an application, some examples are tested to show the accuracy and efficacy of the proposed methods. The obtained result showed that the proposed methods are effective and accurate for this type of problem.