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    The Effects of Topical Insulin Application on Wound Healing
    (Modestum Ltd, 2015) Kargin, Suleyman; Tastekin, Didem; Kilic, Kemal; Cezik, Azamet; Cakir, Murat; Kucukkartallar, Tevfik; Kokbudak, Naile
    The process of wound healing is a dynamic event during which the stages of fibroplasia, angiogenesis, and re-epithelization perfectly take place. The aim of this study is to compare the effects of wound irrigation by normal saline and topical insulin application, which we frequently use in clinical practice, on wound healing. The study covers a total of 20 male rats - 10 for the insulin group and 10 for the control group. The first group received topical insulin application while the second group had irrigation by normal saline. The macroscopic outlook, collagen production, and wound contraction rates in the animals wounds were checked at the end of day 20. The rate of wound closing was found to be higher in the topical insulin group than the NS group at all times. Further, the period of complete wound closing was shorter than the insulin group. Histopathological analysis revealed that the ulceration and inflammation were localized in the subepithelial field in the skin cross-sections of the insulin group and that there was a significant increase in collagen bundles. Thus, we think that insulin can be an alternative to normal saline application specifically in chronic wounds related to diabetes and post-op wound care.
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    The Effects of Topical Insulin Application on Wound Healing
    (Modestum Ltd, 2015) Kargin, Suleyman; Tastekin, Didem; Kilic, Kemal; Cezik, Azamet; Cakir, Murat; Kucukkartallar, Tevfik; Kokbudak, Naile
    The process of wound healing is a dynamic event during which the stages of fibroplasia, angiogenesis, and re-epithelization perfectly take place. The aim of this study is to compare the effects of wound irrigation by normal saline and topical insulin application, which we frequently use in clinical practice, on wound healing. The study covers a total of 20 male rats - 10 for the insulin group and 10 for the control group. The first group received topical insulin application while the second group had irrigation by normal saline. The macroscopic outlook, collagen production, and wound contraction rates in the animals wounds were checked at the end of day 20. The rate of wound closing was found to be higher in the topical insulin group than the NS group at all times. Further, the period of complete wound closing was shorter than the insulin group. Histopathological analysis revealed that the ulceration and inflammation were localized in the subepithelial field in the skin cross-sections of the insulin group and that there was a significant increase in collagen bundles. Thus, we think that insulin can be an alternative to normal saline application specifically in chronic wounds related to diabetes and post-op wound care.
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    Efficacy of regorafenib in the second-and third-line setting for patients with advanced hepatocellular carcinoma: A real life data of multicenter study from Turkey
    (Imprimatur Publications, 2020) Hacioglu, Muhammet Bekir; Kostek, Osman; Karabulut, Senem; Tastekin, Didem; Goksu, Sema Sezgin; Alandag, Celal; Akagunduz, Baran
    Purpose: After failure of the first-line sorafenib treatment in advanced or metastatic stage hepatocellular carcinoma (HCC), regorafenib is one of the newly-approved targeted agents. We aimed to evaluate the efficacy of regorafenib in patients with advanced HCC treated in the secondor third-line setting. Methods: In this retrospective and multicenter study, advanced HCC patients not eligible for local therapies, who received a secondor third-line regorafenib therapy after progression on the first-line sorafenib or sequential therapy with chemotherapy (CT) followed by sorafenib, were included. Results: In the first-line setting, 28 (28.9%) patients received CT and 69 (71.1%) patients received sorafenib. There were 24 (24.7%) patients who were intolerant to sorafenib. Disease control rate (DCR) was 53.6% for all patients treated with regorafenib, 62.3% in patients who received regorafenib in the second-line, and 32.1% for those receiving regorafenib in the third-line (p=0.007). Median progression-free survival (PFS) and overall survival (OS) were 5.6 (range; 4.3-6.9) and 8.8 (range, 6.3-11.3) months for all patients treated with regorafenib vs. 7.1 months and 10.3 months for patients who received regorafenib in the second-line vs. 5.1 and 8.7 months for patients who received regorafenib in the third-line, respectively; however, there was no statistically significant difference (p(PFS)=0.22 and p(OS)=0.85). Conclusion: Although receiving CT as a first-line therapy in advanced HCC patients did not affect the survival rates of subsequent regorafenib therapy, it might diminish the DCR of regorafenib.
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    Evaluation of Prognostic Factors and Adjuvant Chemotherapy in Patients With Small Bowel Adenocarcinoma Who Underwent Curative Resection
    (Cig Media Group, Lp, 2017) Aydin, Dincer; Sendur, Mehmet Ali; Kefeli, Umut; Unal, Olcun Umit; Tastekin, Didem; Akyol, Murat; Tanrikulu, Eda
    This is a multicenter study to assess the prognostic factors and adjuvant chemotherapy in patients with small bowel adenocarcinoma (SBA). A total of 78 patients with SBA diagnosed with completely resected SBA were involved in the study. Only status of surgical margin was determined to be an independent prognostic factor in patients with SBA who underwent curative resection. Neither disease-free survival nor overall survival was found to be significantly improved by the adjuvant chemotherapy Background: Small bowel adenocarcinoma (SBA) is a rare tumor of the gastrointestinal system with poor prognosis. Because these are rarely encountered tumors, the aim of this multicenter study was evaluation of prognostic factors and adjuvant chemotherapy in patients with curatively resected SBA. Materials and Methods: A total of 78 patients diagnosed with curatively resected SBA were involved in the retrospective study. Forty-eight patients received 1 of 3 different chemotherapy regimens, whereas 30 patients did not receive any adjuvant treatment. No adjuvant and adjuvant chemotherapy cohorts were matched (1: 1) by propensity scores based on the likelihood of receiving chemotherapy or the survival hazard from Cox modeling. Overall survival (OS) was compared with Kaplan-Meier estimates. Results: Median age of 78 patients with curatively resected SBA was 58, and 59% of these were men. According to TNM classification, 8 (10%) of the patients were at stage I, 26 (34%) were at stage II, and 44 (56%) were at stage III. Median follow-up duration was 29 months. Three-year median disease-free survival (DFS) and OS were 62.5% and 67.0%, respectively. In univariate analysis, presence of vascular invasion, perineural invasion, lymph node involvement, and presence of positive surgical margin were significant predictors of poor survival. Multivariate analysis showed that the only adverse prognostic factor independently related with OS was the presence of positive surgical margin (hazard ratio, 0.37; 95% confidence interval, 0.11-1.26; P = .01). Neither DFS nor OS was found to be significantly improved by the adjuvant chemotherapy in both matched and unmatched cohorts. Conclusions: Only status of surgical margin was determined to be an independent prognostic factor in patients with SBA who underwent curative resection.
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    Evaluation of prognostic factors and treatment in advanced small bowel adenocarcinoma: report of a multi-institutional experience of Anatolian Society of Medical Oncology (ASMO)
    (Imprimatur Publications, 2016) Aydin, Dincer; Sendur, Mehmet Ali; Kefeli, Umut; Unal, Olcun Umut; Tastekin, Didem; Akyol, Murat; Tanrikulu, Eda
    Purpose: Small bowel adenocarcinoma (SBA) is a rare tumor of the gastrointestinal system with poor prognosis. Since these are rarely encountered tumors, there are limited numbers of studies investigating systemic treatment in advanced SBA. The purpose of this study was to evaluate the prognostic factors and systemic treatments in patients with advance SBA. Methods: Seventy-one patients from 18 Centers with advanced SBA were included in the study. Fifty-six patients received one of the four different chemotherapy regimens as first-line therapy and 15 patients were treated with best supportive care (BSC). Results: Of the 71 patients, 42 (59%) were male and 29 (41%) female with a median age of 56 years. Median follow-up duration was 14.3 months. The median progression free survival (PFS) and overall survival (OS) were 7 and 13 months, respectively (N=71). In patients treated with FOLFOX (N=18), FOLFIRI (N=11), cisplatin-5-fluoroura-cil/5-FU (N=17) and gemcitabine alone (N=10), median PFS was 7, 8, 8 and 5 months, respectively, while median OS was 15, 16, 15 and 11 months, respectively. No significant differences between chemotherapy groups were noticed in terms of PFS and OS. Univariate analysis revealed that chemotherapy administration, de novo metastatic disease, ECOG PS 0 and 1, and overall response to therapy were significantly related to improved outcome. Only overall response to treatment was found to be significantly prognostic in multivariate analysis (p = 0.001). Conclusions: In this study, overall response to chemotherapy emerged as the single significant prognostic factor for advanced SBAs. Platin and irinotecan based regimens achieved similar survival outcomes in advanced SBA patients.
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    Impact of adjuvant treatment modalities on survival outcomes in curatively resected pancreatic and periampullary adenocarcinoma
    (Ame Publ Co, 2015) Turan, Nedim; Benekli, Mustafa; Unal, Olcun Umit; Unek, Ilkay Tugba; Tastekin, Didem; Dane, Faysal; Algin, Efnan
    Background: We examined the impact of adjuvant modalities on resected pancreatic and periampullary adenocarcinoma (PAC). Methods: A total of 563 patients who were curatively resected for PAC were retrospectively analyzed between 2003 and 2013. Results: Of 563 patients, 472 received adjuvant chemotherapy (CT) alone, chemoradiotherapy (CRT) alone, and chemoradiotherapy plus chemotherapy (CRT-CT) were analyzed. Of the 472 patients, 231 were given CRT-CT, 26 were given CRT, and 215 were given CT. The median recurrence-free survival (RFS) and overall survival (OS) were 12 and 19 months, respectively. When CT and CRT-CT groups were compared, there was no significant difference with respect to both RFS and OS, and also there was no difference in RFS and OS among CRT-CT, CT and CRT groups. To further investigate the impact of radiation on subgroups, patients were stratified according to lymph node status and resection margins. In node-positive patients, both RFS and OS were significantly longer in CRT-CT than CT. In contrast, there was no significant difference between groups when patients with node-negative disease or patients with or without positive surgical margins were considered. Conclusions: Addition of radiation to CT has a survival benefit in patients with node-positive disease following pancreatic resection.
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    Synuclein-gamma predicts poor clinical outcome in esophageal cancer patients
    (Sage Publications Ltd, 2014) Tastekin, Didem; Kargin, Suleyman; Karabulut, Mehmet; Yaldiz, Naile; Tambas, Makbule; Gurdal, Necla; Tatli, Ali Murat
    The synuclein gamma (SNCG) protein, a member of neuronal protein family synuclein, has been considered as a promising potential biomarker as an indicator of cancer stage and survival in patients with cancer. The present study was conducted to evaluate the prognostic value of SNCG in patients with esophageal carcinoma (EC). SNCG levels were assessed immunohistochemically in cancer tissues from 73 EC patients. Median age was 57 (range, 29-78) years old. Forty-seven percent of the patients were male. Thirty-seven percent of the patients had upper or middle localized tumor whereas 59 % had epidermoid carcinoma. More than half of the patients (61 %) had undergone operation where 57 % received adjuvant treatment including chemotherapy or chemotherapy plus radiotherapy. Median overall survival was 11.3 +/- 1.8 months (95% confidence interval (CI): 7.7-14.9 months). SNCG positivity was significantly associated with the histological type of EC and inoperability (for SNCG positive vs. negative group; epidermoid 80 vs. 53 %; p=0.05 and inoperable 59 vs. 32 %; p=0.04, respectively). Lymph node metastasis, inoperability and receiving no adjuvant treatment had significantly adverse effect on survival in the univariate analysis (p=0.01, p< 0.001, and p=0.001, respectively). SNCG positivity had significantly adverse effect on survival in both univariate and multivariate analysis (p=0.02 and p=0.01, respectively). Our results are the first to suggest that SNCG is a new independent predictor for poor prognosis in EC patients in the literature.