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Axillary Surgery in Breast Cancer - Primary Results of the INSEMA Trial

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The New England journal of medicine 2024年第12期46卷 2024 Dec 12页

作者： Toralf Reimer Angrit Stachs Kristina Veselinovic Thorsten Kühn Jörg Heil Silke Polata Frederik Marmé Thomas Müller Guido Hildebrandt David Krug beyhan ataseven Roland Reitsamer Sylvia Ruth Carsten Denkert Inga Bekes Dirk-Michael Zahm Marc Thill Michael Golatta Johannes Holtschmidt Michael Knauer Valentina Nekljudova Sibylle Loibl Bernd Gerber From the Department of Obstetrics and Gynecology University of Rostock Rostock Germany (T.R. A.S. B.G.) University Hospital Ulm Ulm Germany (K.V. I.B.) Hospital Esslingen Esslingen Germany (T.K.) University Hospital Heidelberg Heidelberg Germany (J. Heil M.G.) the Breast Unit Sankt Elisabeth Hospital Heidelberg Germany (J. Heil M.G.) Evang. Waldkrankenhaus Spandau Berlin (S.P.) the Faculty of Medicine Mannheim Department of Obstetrics and Gynecology University of Heidelberg Mannheim Germany (F.M.) the Department of Obstetrics and Gynecology Hanau City Hospital Hanau Germany (T.M.) the Department of Radiation Oncology University Hospital Rostock Rostock Germany (G.H.) the Department of Radiotherapy and Radiation Oncology University Hospital Hamburg-Eppendorf (UKE) Hamburg Germany (D.K.) the Department of Radiation Oncology University Medical Center Schleswig-Holstein Kiel Germany (D.K.) Medical School and University Medical Center OWL Department of Gynecology and Obstetrics Bielefeld University Klinikum Lippe Detmold Germany (B.A.) Salzburg Regional Hospital Salzburg Austria (R.R.) Johanniter-Hospital Genthin-Stendal Genthin Germany (S.R.) the Institute of Pathology Philipps-University Marburg and University Hospital Marburg (UKGM) Marburg Germany (C.D.) Breast Center St. Gallen Kantonsspital St. Gallen Switzerland (I.B.) SRH Wald-Klinikum Gera Gera Germany (D.-M.Z.) the Department of Gynecology and Gynecologic Oncology Agaplesion Markus Hospital Frankfurt am Main Germany (M.T.) the German Breast Group Neu-Isenburg Germany (J. Holtschmidt V.N. S.L.) and the Tumor and Breast Center Eastern Switzerland St. Gallen Switzerland (M.K.).

BACKGROUND:Whether surgical axillary staging as part of breast-conserving therapy can be omitted without compromising survival has remained unclear.METHODS:In this prospective, randomized, noninferiority trial, we investigated the omission of axillary surgery as compared with sentinel-lymph-node biopsy in patients with clinically node-negative invasive breast cancer staged as T1 or T2 (tumor size, ≤5 cm) who were scheduled to undergo breast-conserving surgery. We report here the per-protocol analysis of invasive disease-free survival (the primary efficacy outcome). To show the noninferiority of the omission of axillary surgery, the 5-year invasive disease-free survival rate had to be at least 85%, and the upper limit of the confidence interval for the hazard ratio for invasive disease or death had to be below 1.271.RESULTS:A total of 5502 eligible patients (90% with clinical T1 cancer and 79% with pathological T1 cancer) underwent randomization in a 1:4 ratio. The per-protocol population included 4858 patients; 962 were assigned to undergo treatment without axillary surgery (the surgery-omission group), and 3896 to undergo sentinel-lymph-node biopsy (the surgery group). The median follow-up was 73.6 months. The estimated 5-year invasive disease-free survival rate was 91.9% (95% confidence interval [CI], 89.9 to 93.5) among patients in the surgery-omission group and 91.7% (95% CI, 90.8 to 92.6) among patients in the surgery group, with a hazard ratio of 0.91 (95% CI, 0.73 to 1.14), which was below the prespecified noninferiority margin. The analysis of the first primary-outcome events (occurrence or recurrence of invasive disease or death from any cause), which occurred in a total of 525 patients (10.8%), showed apparent differences between the surgery-omission group and the surgery group in the incidence of axillary recurrence (1.0% vs. 0.3%) and death (1.4% vs. 2.4%). The safety analysis indicates that patients in the surgery-omission group had a lower incidence

关键词： trial surgery axillary breast cancer-primary insema results

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

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World Journal of Clinical Cases 2020年第10期8卷 1859-1870页

作者： Murat beyhan Berat Acu Erkan Gokce Mehmet Murat Firat Department of Radiology Tokat Gaziosmanpasa University Faculty of MedicineTokat 60100Turkey Department of Radiology Eskisehir Osmangazi University Faculty of MedicineEskisehir 26480Turkey Department of Radiology Guven HospitalAnkara 06540Turkey

BACKGROUND Almost 90%of cerebral thromboembolism cases are caused by *** atherosclerosis is often observed at the carotid bifurcation and is responsible for 20%-30%of all stroke *** course of atherosclerotic carotid artery stenosis varies depending on the grade of stenosis and characteristics of the *** artery stenting(CAS)can be used as a less invasive method in patients with symptomatic and asymptomatic high-grade carotid artery ***-weighted imaging(DWI)is an effective method for detection of silent or symptomatic acute ischemic lesions that may arise due to CAS or carotid *** number and volume of new ischemic lesions are determined using *** To evaluate the number and volume of ischemic lesions and their cerebral parenchymal and vascular distribution after CAS using *** 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 *** of the cases(18.8%)were asymptomatic,while fifty-two(81.2%)were *** area where the stenosis was highest was measured,and the stenosis rate was determined using the North American Symptomatic Carotid Endarterectomy Trial *** of the cases was evaluated by two radiologists experienced in neuroradiology(*** more than 15 years of experience,*** 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 *** 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 *** In the present study,39 new ischemic lesions were detected in 20 *** average number of new lesions after all CAS operations was *** were mostly located in the occipital lobes,followed by

关键词： Carotid artery stenosis Carotid artery stenting Diffusion-weighted imaging Ischemia Stroke

Primary sclerosing cholangitis in Turkish patients:characteristic features and prognosis

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Hepatobiliary & Pancreatic Diseases International 2009年第3期8卷 312-315页

作者： Hilmi ataseven Erkan Parlak lhami Yüksel mer Ba■ar brahim Ertu■rul Nurgül ■a■maz Burhan ■ahin Department of Gastroenterology Türkiye Yüksek htisas Hospital Department of Gastroenterology Di■kapl Yildirlm Beyazlt Education and Research Hospital

BACKGROUND:Primary sclerosing cholangitis(PSC)is a chronic cholestatic liver disease characterized by destruction and fibrosis of the bile *** study aimed to demonstrate the hepatic and extrahepatic characteristic findings and prognostic outcomes of Turkish patients with PSC. METHODS:The medical records of 35 consecutive patients with PSC from January 1988 to June 2007 were recorded *** the time of diagnosis,clinical features and laboratory data were collected. RESULTS:The mean age of the 35 patients was 41.69 years (range 15-80 years)at the time of diagnosis;14(40%)were female,and 21(60%)were *** mean duration of follow-up was 58.86 months(1-180 months).Twenty(57.1%) of the patients with PSC were asymptomatic and 22(62.9%) had inflammatory bowel *** the time of diagnosis, 20(57.1%)of the patients had both intra-and extra-hepatic ***-one(60%)of the patients,who had undergone ERCP for stent placement,had dominant bile duct stenosis. Cholangiocarcinoma was found in 2(5.7%)of the patients and cirrhosis was detected in 7(20%);5(14.3%)underwent liver *** median follow-up time after liver transplantation was 23 months and all are still *** (17.1%)patients died. CONCLUSIONS:PSC has a clinical course varied from advanced liver disease requiring liver transplantation within a short time to being asymptomatic for decades. The prognosis of Turkish patients with PSC is also disappointing as described in other studies.

关键词： primary sclerosing cholangitis cholestatic liver diseases biliary tree endoscopic retrograde cholangiopancreatography

Radiological imaging findings of scheuermann disease

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World Journal of Radiology 2016年第11期8卷 895-901页

作者： Erkan Gokce Murat beyhan Department of Radiology School of MedicineGaziosmanpasa University Department of Radiology Tokat State Hospital

AIM To find accompanying anomalies of typical and atypical Scheuermann's disease(SD) is reported in the present study. METHODS Study included 20 patients(16 men and 4 women) who had radiological imaging radiography, magnetic resonance imaging(MRI) and computed tomography, if available, due to back pain, curved back and low back pain in November 2011-February 2016 period. Patients were categorized into typical and atypical patterns based on the region involved. Thoracic kyphosis values were measured using real Cobb angle. Accompanying disc degeneration, herniations and spinal cord pathologies were studied using *** Age of the patients ranged from 11.0 to 23.0(mean 17.2 ± 3.0). Typical pattern of SD were detected in 15 patients while atypical pattern were detected in 5 patients. Cobb angle range was 40.2-67.2(mean 55.5 ± 8.7) in typical Scheuermann's patients and 24.7-49.9(mean 36.7 ± 10.8) in atypical ones. Intervertebral level was affected and had the measures of 3-8(mean 5.3 ± 1.6) and 7-9(mean 8.2 ± 0.8) in typical and atypical Scheuermann's patients, respectively. Level of degenerative disc disease in MRI was 1-7 discs(mean 4.1 ± 1.7) in typical patients and 5-10 discs(mean 7.6 ± 1.9) in atypical *** SD can be seen in typical and atypical patterns, typical being more frequent. Because degenerative disc diseases,herniations and cord pathologies such as syringomyelia can accompany SD(albeit more common in atypical pattern), it is necessary to evaluate these patients with plain radiography and MRI together.

关键词： Cobb angle Magnetic resonance imaging Juvenile kyphosis Scheuermann’s disease Thoracic kyphosis

Genetic gains in wheat in Turkey:Winter wheat for irrigated conditions

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The Crop Journal 2015年第6期3卷 507-516页

作者： Nurberdy Gummadov Mesut Keser beyhan Akin Mustafa Cakmak Zafer Mert Seyfi Taner Irfan Ozturk Ali Topal Selami Yazar Alexey Morgounov International Maize and Wheat Improvement Center(CIMMYT) International Center for Agricultural Research in the Dry Areas(ICARDA) Transitional Zone Agricultural Research Institute Field Crops Central Research Institute Bahri Dagdas International Agricultural Research Institute Trakya Agricultural Research Institute Selcuk University Faculty of Agriculture

The study estimated genetic gain for yield and other traits in winter wheat released for irrigated environments in Turkey from 1963 to 2004. Yield trials including 14 varieties were grown in 16 environments from 2008 to 2012 in provinces of Konya, Eski?ehir, Ankara, and Edirne. The highest yields were achieved by recent varieties Kinaci-97(5.48 t ha^(-1)),Cetinel-2000(5.39 t ha^(-1)), Alpu-2001(5.44 t ha^(-1)), Ahmetaga(5.35 t ha^(-1)), and Ekiz-2004(5.42 t ha^(-1)) compared to older varieties Yektay-406(4.17 t ha^(-1)) and Bezostaya-1(4.27 t ha^(-1))released in the 1960 s. The progress reached in grain yield in 20 years was 1.16 t ha^(-1)or58 kg ha^(-1)(1.37%) per year. This gain was mainly achieved through shorter plant height and increased harvest index. There was no clear tendency of changes in specific yield components demonstrating that new high-yielding varieties may have different ways to reach their yield potentials. The yield gains were accompanied by improved stripe rust and leaf rust resistances primarily based on adult plant resistance genes. The grain quality of the new varieties did not deteriorate over time although most of them were inferior to the bread-making quality check Bezostaya-1, a feature that may require attention in future breeding.

关键词： Bread wheat Yield potential Reduced plant height Irrigated environment

Evaluation of pineal cysts with magnetic resonance imaging

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World Journal of Radiology 2018年第7期10卷 65-77页

作者： Erkan Gokce Murat beyhan Department of Radiology Gaziosmanpasa Uni-versitySchool of Medicine Department of Radiology Tokat State Hospital

AIM To evaluate radiological imaging findings of patients who had been found to have pineal cyst(PC) in brain magnetic resonance imaging(MRI).METHODS A total of 9546 patients who had brain MRI examination in March 2010-January 2018 period were *** patients(44 female and 12 male) found to have PC were *** of the patients had had follow-up examinations of 2-94 mo(mean 30.50 ± 28.83).PC dimensions and volume,radiological imaging features(signal intensities,contours,internal septationloculation and contrast-enhancement features) and natural history in cases who had been followed-up were evaluated by two *** Of 9546 patients,5555 were female(58.2%) and 3991 male(41.8%).Age range was 1-99(mean 43.18 ± 20.94).PC frequency was calculated to be 0.58%.Forty-four of the 56 patients(78.57%) with PC were female and 12 male(21.43%),and their age range was 5-61(mean 31.26 ± 12.73).Thirty-five of the PCs were typical(62.50%) and 21(37.50%) were *** significant difference was found between initial and final imaging sizes of PCs which were monitored by follow-up examinations(P > 0.05).CONCLUSION PCs are cysts which do not show clear size and natural changes and are more frequently observed in females and in adult *** of them are isointense with cerebrospinal fluid on T1 and T2 A weighted images,hyperintense compared to cerebrospinal fluid on fluidattenuated inversion recovery; sequence and smoothly *** typical forms have peripheral rim and multilocular ones may have septal contrast-enhancement.

关键词： Magnetic resonance imaging Pineal cyst Pineal region

International Winter Wheat Improvement Program: history,activities, impact and future

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Frontiers of Agricultural Science and Engineering 2019年第3期6卷 240-250页

作者： Alexey MORGOUNOV Fatih OZDEMIR Mesut KESER beyhan AKIN Thomas PAYNE Hans-Joachim BRAUN International Maize and Wheat Improvement Center(CIMMYT) Ankara06511Turkey Bahri Dagdas International Agricultural Research Institute Konya42001Turkey International Center for Agricultural Research in Dry Areas(ICARDA) Ankara06511Turkey International Maize and Wheat Improvement Center(CIMMYT) Texcoco56100Mexico

International Winter Wheat Improvement Program(IWWIP) was established in 1986 between the Government of Turkey and CIMMYT with three main objectives:(1) develop winter/facultative germplasm for Central and West Asia,(2) facilitate global winter wheat germplasm exchange, and(3) training wheat *** joined the program in 1991 making it a threeway partnership that continues to work *** germplasm developed by IWWIP as well as the winter wheat cultivars and lines received from global cooperators are assembled into international *** nurseries are offered annually to public and private entities(IWWIP website) and distributed to more than 100 cooperators in all *** impact has primarily been in new winter wheat cultivars combining broad adaptation, high yield potential, drought tolerance and disease resistance.A total of 93 IWWIP cultivars have been released in 11 countries occupying annually an estimated 2.5–3.0 *** cooperation with researchers in Turkey, Central and West Asia and several US universities has resulted in a number of publications reviewed in this *** IWWIP impacts include national inventories of wheat landraces in Turkey, Tajikistan and Uzbekistan, their collection, characterization, evaluation and utilization.

关键词： biotic and abiotic stresses breeding methodology winter wheat

Genetic gains in wheat in Turkey: Winter wheat for dryland conditions

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The Crop Journal 2017年第6期5卷 533-540页

作者： Mesut Keser Nurberdy Gummadov beyhan Akin Savas Belen Zafer Mert Seyfi Taner Ali Topal Selami Yazar Alexey Morgounov Ram Chandra Sharma Fatih Ozdemir International Center for Agricultural Research in the Dry Areas (ICARDA) Yenimahalle Ankara 06170 Turkey International Maize and Wheat Improvement Center (CIMMYT) Yenimahalle Ankara 06170 Turkey Transitional Zone Agricultural Research Institute Tepebasi Eskisehir 26005 Turkey Central Research Institute for Field Crops Ankara 06170 Turkey Bahri Dagdas International Agricultural Research Institute Konya 42050 Turkey Department of Field Crops Faculty of Agriculture Selcuk University Konya 42030 Turkey International Center for Agricultural Research in the Dry Areas (ICARDA) Tashkent Uzbekistan

Wheat breeders in Turkey have been developing new varieties since the 1920 s, but few studies have evaluated the rates of genetic improvement. This study determined wheat genetic gains by evaluating 22 winter/facultative varieties released for rainfed conditions between 1931 and2006. The study was conducted at three locations in Turkey during 2008-2012, with a total of 21 test sites. The experimental design was a randomized complete block with four replicates in2008 and 2009 and three replicates in 2010-2012. Regression analysis was conducted to determine genetic progress over time. Mean yield across all 21 locations was 3.34 t ha^(-1) but varied from 1.11 ha^(-1) to 6.02 t ha^(-1) and was highly affected by moisture stress. Annual genetic gain was 0.50% compared to Ak-702, or 0.30% compared to the first modern landmark varieties. The genetic gains in drought-affected sites were 0.75% compared to Ak-702 and0.66% compared to the landmark varieties. Modem varieties had both improved yield potential and tolerance to moisture stress. Rht genes and rye translocations were largely absent in the varieties studied. The number of spikes per unit area decreased by 10% over the study period,but grains spike^(-1) and 1000-kemel weight increased by 10%. There were no significant increases in harvest index, grain size, or spike fertility, and no significant decrease in quality over time. Future use of Rht genes and rye translocations in breeding programs may increase yield under rainfed conditions.

关键词： Genetic gain Rainfed wheat production Winter wheat Yield

Diagnostic efficacy of diffusion-weighted imaging and semiquantitative and quantitative dynamic contrast-enhanced magnetic resonance imaging in salivary gland tumors

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World Journal of Radiology 2023年第1期15卷 20-31页

作者： Erkan Gökçe Murat beyhan Department of Radiology Tokat Gaziosmanpasa UniversityFaculty of MedicineTokat 60100Turkey

BACKGROUND Increased use of functional magnetic resonance imaging(MRI)methods such as diffusion-weighted imaging(DWI)and dynamic contrast-enhanced(DCE)MRI consisting of sequential contrast series,allows us to obtain more information on the microstructure,cellularity,interstitial distance,and vascularity of tumors,which has increased the discrimination power for benign and malignant salivary gland tumors(SGTs).In the last few years,quantitative DCE MRI data containing T1 perfusion parameters(K_(trans),K_(ep)and V_(e)),were reported to contribute to the differentiation of benign or malignant subtypes in *** To evaluate the diagnostic efficacy of DWI and semiquantitative and quantitative perfusion MRI parameters in *** Diffusion MRI[apparent diffusion coefficient(ADC)value]with a 1.5 T MR machine,semiquantitative perfusion MRI[time intensity curve(TIC)pattern],and quantitative perfusion MRI examinations(K_(trans),K_(ep)and V_(e))of 73 tumors in 67 patients with histopathological diagnosis performed from 2017 to 2021 were retrospectively *** the ADC value and semiquantitative perfusion MRI measurements,cystic components of the tumors were not considered,and the region of interest(ROI)was manually placed through the widest axial section of the *** patterns were divided into four groups:Type A=T_(peak)>120 s;type B=T_(peak)≤120 s,washout ratio(WR)≥30%;type C=T_(peak)≤120 s,WR<30%;and type D=flat *** the quantitative perfusion MRI analysis,a 3D ROI was placed in the largest solid component of the tumor,and the K_(trans),K_(ep)and V_(e)values were automatically *** The majority of SGTs were located in the parotid glands(86.3%).Of all the SGTs,68.5%were benign and 31.5%were *** differences were found for ADC values among pleomorphic adenomas(PMAs),Warthin's tumors(WTs),and malignant tumors(MTs)(P<0.001).PMAs had type A and WTs had type B TIC pattern while the vast majority of MTs and other benign tumors(OBTs)(5

关键词： salivary diffusion dynamic