Possible Logistic and Sociodemographyc Factors on Breast Cancer Screening in Turkey: Lessons from a Women’s Health Project in Mersin Province

Mortality from breast cancer is decreasing partly owing to early detection. In Mersin province in our country, local health authorities launched an education program on sexual diseases and breast cancer early detection for women over 15 years of age. After the educational session, clinical breast examination was offered by a nurse or physician, and if suspicious they were recommended to apply a specialist for further examination. Here, we report the results on those women with abnormal clinical breast examination. In this second project, socio-demographic variables were investigated such as educational level and place of living,parameters to measure the success of previous project, whether they followed the recommendation themselves, whether mammograms were reported in accordance with Breast Imaging Reporting and Data System (BIRADS). Of 3,793 women recruited, mean age was 42.2 years, 42.3%were younger than 40.0 years. Majority (88.5%) were married, graduate of primary school (60.6%), without a job(91.2%), and inhabiting in the province (38.7%). Of the population, 98.1% believe in the importance of screening in the treatment of breast cancer. According to 70.3%,monthly breast self-examination enables early detection, 33.5% believe that clinical breast examination detects cancer early, and 35.5% think that annual mammography can detect it early. Among 2,183 women 40 years of age or over, 41.5% had mammography at once before participating in the first project. Breast self-examination was being carried out by 56.6% on a monthly basis. After an abnormal breast examination, 86.4% applied to hospitals for specialist examination. Reasons for declining to seek for further examination among 410 women answering were as follows:42.0% did not accept, 27.0% did not know it was important, 16.6% because of economical reasons, and 5.0% were too shy to be examined. Being older, being married, being the graduate of primary and secondary school, residing in rural areas, having a mammogram positively affected the decision in univariate analyses (p<0.05). All but educational level (p=0.059) remained significant in multivariate analysis. Mammography was reported in accordance with BIRADS in only 45 (1.2%). Awareness of population on breast cancer early detection can be raised through education. Generally, women follow professional recommendation from professionals. Mammography reporting among radiologist in accordance with BIRADS is rare. Successful early detection of breast cancer may be obtained by public education together with improving detection methods.     

Do thrombophilic gene mutations have a role on thromboembolic events in cancer patients?

Aim: Thromboembolism is common in patients with cancer and may be considered a major cause of morbidity and mortality. We studied the most common genetic polymorphism characteristics that may have roles in the development of thrombosis in patients with cancer. Methods: A total of 158 patients with cancer who had had any thrombotic event were included, together with a control group of 134 patients with cancer without a thromboembolic event. The presence of mutations (Factor V Leiden G1691A, prothrombin G20210A) and polymorphisms (methylenetetrahydrofolate reductase [MTHFR] C677T and plasminogen activator inhibitor (PAI‐1) 4G/5G) were analysed. Results: A heterozygous polymorphism for Factor V Leiden G1691A was found in 48 patients (30.3%) and a homozygous polymorphism in only one (0.63%), compared to 32 heterozygous (23.8%) and one homozygous (0.74%) polymorphism in the control group (P = 0.462). Prothrombin G20210A heterozygous polymorphism was observed in 11(6.9%) and four (2.5%) in the patients and controls, respectively. The MTHFR C677T heterozygous polymorphism was found in 48 (30.3%) and 24 (15.1%) and the homozygous polymorphism was observed in 15 (9.4%) and 12 (7.5%) in the study and control group, respectively (P = 0.04). Conclusion: Although we found a statistically significant difference between patients with and without thrombosis in respect to MTHFR C677T gene mutation, our data suggest that we do not have enough evidence yet to recommend performing genetic analysis.     

Long-Term Effects of Rapid Maxillary Expansion Followed by Fixed Appliances

Objective:To evaluate the long-term changes in maxillary arch widths, overjet, and overbite in patients who were treated with rapid maxillary expansion (RME) followed by edgewise appliances.Materials and Methods:The material for the study consisted of study casts taken from 41 patients (19 males, 22 females) on four different occasions (before treatment, T1; after RME, T2; after treatment, T3; and during follow-up period, T4). The upper intercanine, interpremolar, and intermolar widths and overjet and overbite were measured on each set of study casts. Mean age of the subjects was 13.2 ± 1.3 years (range, 11.2–16.9 years) at T1, 13.3 ± 1.3 years (range, 11.3–17 years) at T2, 15.5 ± 1.4 years (range, 13.1–18.8 years) at T3, and 20.4 ± 1.6 years (range, 17.9–24.8 years) at T4.Results:The net increase in intercanine width, interpremolar width, intermolar width, overjet, and overbite was 1.4 ± 2.4 mm, 4.6 ± 2.6 mm, 4.3 ± 2.5 mm, 0.1 ± 0.6 mm, and 0.2 ± 0.6 mm, respectively, and the relapse rates were 37% for intercanine width, 19% for interpremolar width, and 17% for intermolar width at the end of the follow-up period.Conclusions:A significant amount of relapse occurred in maxillary arch widths at the postretention assessment, the greatest being in intercanine width. RME significantly decreased overbite and increased overjet, and a statistically significant decrease was observed in both overbite and overjet at the postretention assessment.     

Cure Kinetics and Inverse Analysis of Epoxy-Amine Based Adhesive Used for Fastening Systems

Thermosetting polymers are used in building materials, for example adhesives in fastening systems. They harden in environmental conditions with a daily temperature depending on the season and location. This curing process takes hours or even days effected by the relatively low ambient temperature necessary for a fast and complete curing. As material properties depend on the degree of cure, its accurate estimation is of paramount interest and the main objective in this work. Thus, we develop an approach for modeling the curing process for epoxy based thermosetting polymers. Specifically, we perform experiments and demonstrate an inverse analysis for determining parameters in the curing model. By using calorimetry measurements and implementing an inverse analysis algorithm by using open-source packages, we obtain 10 material parameters describing the curing process. We present the methodology for two commercial, epoxy based products, where a statistical analysis provides independence of material parameters leading to the conclusion that the material equation is adequately describing the material response.     

Impact of aspirin therapy in cancer patients with thrombocytopenia and acute coronary syndromes

BACKGROUND.

Patients with cancer who have thrombocytopenia may experience acute coronary syndromes (ACS), and the use of aspirin (ASA) poses an increased risk of bleeding. The purpose of this study was to test the hypothesis that the benefit of ASA therapy in the treatment of ACS would extend to cancer patients with thrombocytopenia and outweigh the risks of severe bleeding.

METHODS.

The records of all cancer patients diagnosed with an ACS in 2001 and referred for cardiology consultation were reviewed. Patients were divided into 2 groups on the basis of platelet count, >100 cells k/μL and ≤100 cells k/μL. Data were collected on the use of ASA therapy, bleeding complications, and survival rates. The authors assessed group differences by using the Wilcoxon rank sum test or 2‐tailed Fisher exact test, as appropriate. Univariate and multivariate logistic regression models were used to assess factors potentially associated with 7‐day survival.

RESULTS.

In cancer patients with ACS and thrombocytopenia, those who did not receive ASA had a 7‐day survival rate of 6% compared with 90% in those who did receive ASA (P < .0001). There were no severe bleeding complications. Patients with a platelet count (>100 cells k/μL) who received ASA had a 7‐day survival rate of 88% compared with 45% in those who did not receive ASA (P = .0096).

CONCLUSIONS.

Therapy with ASA was associated with a significantly improved 7‐day survival after ACS in cancer patients, with or without thrombocytopenia, and not associated with more severe bleeding. Cancer 2007;109:621–627. © 2006 American Cancer Society.     

Epidemiologic variability of chronic inflammatory demyelinating polyneuropathy with different diagnostic criteria: Study of a UK population

Epidemiologic data on chronic inflammatory demyelinating polyneuropathy (CIDP) is limited, and previous studies have shown variable results. The frequencies of CIDP subtypes remain unknown. Variations due to use of different diagnostic criteria have not been studied. We examined the prevalence and incidence of CIDP in Leicestershire and Rutland, UK (population 963,600). Prevalence day was 1 May 2008. The prevalence of CIDP fulfilling the 2006 clinical and electrophysiologic European Federation of Neurological Societies/Peripheral Nerve Society (EFNS/PNS) criteria was 4.77 per 100,000 (95% confidence interval [CI] 3.49–6.37). Using the 1991 American Academy of Neurology (AAN) criteria, the prevalence was 1.97 per 100,000 in this population (95% CI 1.19–3.08). Lewis–Sumner syndrome was diagnosed in 15.2% of patients, and 23.9% had pure sensory onset. Over 40% required no immunotherapy, and 84.6% of those treated responded. More than 80% of the AAN criteria–negative but EFNS/PNS criteria–positive patients were responsive to treatment. Both sets of criteria were equally likely to identify patients who required therapy. The mean annual incidence rate over the 3 years preceding the prevalence day was 0.70 per 100,000/year using EFNS/PNS criteria (95% CI 0.43–1.08), and 0.35 per 100,000/year using AAN criteria (95% CI 0.17–0.64). We conclude that the AAN criteria may underestimate prevalence and incidence of the disease. The EFNS/PNS criteria provide higher diagnostic sensitivity and are of greater clinical relevance, and they also offer a useful breakdown of the epidemiologic data for CIDP subtypes. Muscle Nerve, 2008     

Possible association of the 5-HTTLPR serotonin transporter promoter gene polymorphism with premature ejaculation in a Turkish population

We evaluated the genotypes of the serotonin transporter gene （5-HTT） in patients with premature ejaculation （PE） to determine the role of genetic factors in the etiopathogenesis of PE and possibly to identify the patient subgroups. A total of 70 PE patients and 70 controls were included in this study. All men were heterosexual, had no other disorders and were either married or in a stable relationship. PE was defined as ejaculation that occurred within 1 min of vaginal intromission. Genomic DNA from patients and controls was analyzed using polymerase chain reaction, and allelic variations of the promoter region of the serotonin transporter gene （5-HTTLPR） were determined. The 5-HTTLPR （serotonin transporter promoter gene） genotypes in PE patients vs. controls were distributed as follows： L/L 16% vs. 17%, L/S 30% vs. 53% and S/S 54% vs. 28%. We examined the haplotype analysis for three polymorphisms of the 5-HTTLPR gene： LL, LS and SS. The appropriateness of the allele frequencies in the 5-HTTLPR gene was analyzed by the Hardy-Weinberg equilibrium using the Z-test. The short （S） allele of the 5-HTTLPR gene was significantly more frequent in PE patients than in controls （P 〈 0.05）. We suggest that the 5-HTTLPR gene plays a role in the pathophysiology of all primary PE cases. Further studies are needed to evaluate the relationship between 5-HTTLPR gene polymorphism and patient subgroup （such as primary and secondary PE） responses to selective serotonin reuptake inhibitors as well as ethnic differences.