5 research outputs found
An Unusual Case of Metastatic Gastric Cancer Presenting with Right Heart Failure and Cardiac Metastasis
No full textCardiac metastasis is rarely detected in oncology practice. Herein we present a rare case of metastatic gastric cancer that metastasized to the right atrium and presented with right heart failure. A 51-year-old male patient with no known chronic disease presented with fatigue, abdominal distension and leg edema for 3 weeks. Physical examination revealed abdominal ascites, tachycardia and pretibial edema. Transthoracic echocardiography (TTE) revealed a hypoechoic, less-mobile mass that almost completely filled the right atrium. Moreover, 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) showed metastatic lesions and a primary tumor-suspicious area in the esophagogastric component. Upper GI endoscopic evaluation performed on the patient revealed an ulcerovegetating mass consistent with gastric adenocarcinoma. A human epidermal growth factor receptor 2 (HER-2) was positiveand programmed death-ligand 1 (PD-L1) combined positive score (CPS) was detected as 15 in immunohistochemistry (IHC). Thereafter, an anticoagulant treatment was started including pembrolizumab and trastuzumab every three weeks, and an oxaliplatin and 5-FU-based chemotherapy regimen was started every two weeks. There was no regression in the cardiac lesion during follow-up; thereafter, there was a significant risk of cardioembolic complications, and a 10 × 7 cm mass filling the right atrium and adhering to the inferior vena cava was resected. The pathology results of the excision material reported gastric carcinoma metastasis. Systemic evaluation performed 3 months later showed regression in primary and metastatic lesions. Cardiac metastases are rare and may not be discovered until autopsy due to the prominence of primary disease findings. Cardiac metastasis, although rare, should be kept in mind in gastric cancer patients presenting with heart failure
Efficacy of Second-Line Treatments After Atezolizumab and Bevacizumab in Advanced Hepatocellular Carcinoma and Related Prognostic Factors: a Multicenter Study by the Turkish Oncology Group (Tog)
No full textAlan, Ozkan/0000-0002-6635-2012; Gunenc, Damla/0000-0002-7592-2021Background/Aims: The treatment of hepatocellular carcinoma (HCC), which accounts for 90% of all liver cancers, is highly varied. The use of second-line treatments following progression on first-line atezolizumab and bevacizumab (Atez/Bev) for advanced HCC remains controversial. The aim of this study was to analyze the real-world clinical results of second-line treatments in progression after Atez/Bev and to determine the factors affecting prognosis. Materials and Methods: Fifty-eight patients treated with second-line sorafenib, regorafenib, and cabozantinib for progression after first-line Atez/Bev for advanced/metastatic HCC from 20 centers in T ; uuml;rkiye between October 2020 and June 2024 were retrospectively analyzed. Responses were evaluated by Response criteria, specifically Response Evaluation Criteria in Solid Tumors (RECIST v1.1) criteria. Median overall survival (OS) and progression-free survival (PFS) were computed with the Kaplan-Meier method. The Cox regression model was utilized to analyze multivariate analyses. Results: About 82.8% of the patients were male and the median age of the whole group was 62 (range, 18-78) years. All patients progressed after first-line Atez/Bev and were given second-line treatment. The most commonly used second-line treatment option was sorafenib (70.7%), followed by regorafenib (12.1%) and cabozantinib (10.3%). Both median PFS (4.1 months) and median OS (7.8 months) were longer in patients treated with sorafenib compared to other treatments. In univariate analyses, Child-Pugh score B, high alpha-fetoprotein (AFP) levels (>200 ng/mL), extrahepatic spread, and Prognostic Nutritional Index (PNI) 47.6 substantially raised the risk of overall mortality. Multivariate analysis showed that extrahepatic spread (HR (Hazard ratio): 0.41, P = .012), PNI level (HR: 0.24, P = .005), and AFP level (HR:1.97, P = .049) were independent predictors of OS. Conclusion: Although second-line therapies after Atez/Bev show different degrees of efficacy, survival rates are consistent with the literature. Extrahepatic spread, AFP level, and PNI level are the main prognostic factors. In light of this information, personalized treatment strategies may improve outcomes for this challenging patient group
Efficacy of Second-Line Treatments After Atezolizumab and Bevacizumab in Advanced Hepatocellular Carcinoma and Related Prognostic Factors: A Multicenter Study by the Turkish Oncology Group (TOG)
No full textBackground/Aims: The treatment of hepatocellular carcinoma (HCC), which accounts for 90% of all liver cancers, is highly varied. The use of second-line treatments following progression on first-line atezolizumab and bevacizumab (Atez/Bev) for advanced HCC remains controversial. The aim of this study was to analyze the real-world clinical results of second-line treatments in progression after Atez/Bev and to determine the factors affecting prognosis. Materials and Methods: Fifty-eight patients treated with second-line sorafenib, regorafenib, and cabozantinib for progression after first-line Atez/Bev for advanced/metastatic HCC from 20 centers in T & uuml;rkiye between October 2020 and June 2024 were retrospectively analyzed. Responses were evaluated by Response criteria, specifically Response Evaluation Criteria in Solid Tumors (RECIST v1.1) criteria. Median overall survival (OS) and progression-free survival (PFS) were computed with the Kaplan-Meier method. The Cox regression model was utilized to analyze multivariate analyses. Results: About 82.8% of the patients were male and the median age of the whole group was 62 (range, 18-78) years. All patients progressed after first-line Atez/Bev and were given second-line treatment. The most commonly used second-line treatment option was sorafenib (70.7%), followed by regorafenib (12.1%) and cabozantinib (10.3%). Both median PFS (4.1 months) and median OS (7.8 months) were longer in patients treated with sorafenib compared to other treatments. In univariate analyses, Child-Pugh score B, high alpha-fetoprotein (AFP) levels (>200 ng/mL), extrahepatic spread, and Prognostic Nutritional Index (PNI) < 47.6 substantially raised the risk of overall mortality. Multivariate analysis showed that extrahepatic spread (HR (Hazard ratio): 0.41, P = .012), PNI level (HR: 0.24, P = .005), and AFP level (HR:1.97, P = .049) were independent predictors of OS. Conclusion: Although second-line therapies after Atez/Bev show different degrees of efficacy, survival rates are consistent with the literature. Extrahepatic spread, AFP level, and PNI level are the main prognostic factors. In light of this information, personalized treatment strategies may improve outcomes for this challenging patient group
Global impoverishment of natural vegetation revealed by dark diversity
No full textAnthropogenic biodiversity decline threatens the functioning of ecosystems and the many benefits they provide to humanity . As well as causing species losses in directly affected locations, human influence might also reduce biodiversity in relatively unmodified vegetation if far-reaching anthropogenic effects trigger local extinctions and hinder recolonization. Here we show that local plant diversity is globally negatively related to the level of anthropogenic activity in the surrounding region. Impoverishment of natural vegetation was evident only when we considered community completeness: the proportion of all suitable species in the region that are present at a site. To estimate community completeness, we compared the number of recorded species with the dark diversity-ecologically suitable species that are absent from a site but present in the surrounding region . In the sampled regions with a minimal human footprint index, an average of 35% of suitable plant species were present locally, compared with less than 20% in highly affected regions. Besides having the potential to uncover overlooked threats to biodiversity, dark diversity also provides guidance for nature conservation. Species in the dark diversity remain regionally present, and their local populations might be restored through measures that improve connectivity between natural vegetation fragments and reduce threats to population persistence. [Abstract copyright: © 2025. The Author(s).
Gospel and culture - accommodation or tension? : an enquiry into the priorities of the Gospel in the light of Jamaica's historico-cultural experience vis-à-vis Western Christian civilization
No full textIn this thesis we enquire into the essence and mission of
Christianity in the light of the Jamaican historico-cultural experience.
Chapter one is devoted to a partial investigation into the nature of
Western Christianity vis-a-vis Western Civilization - the modern dilemma,
its historical beginnings and development, its response to philosophical
ideas and other cultural positions, Church-State relations, its divisions,
and its social attitude.
We next identify the major elements in the Jamaican experience as
revealed in the impact of the Spanish conquest on the original Arawak
population, the enslavement of African Peoples, and the post-slavery
repercussions vis-a-vis Western Christianity.
In order better to understand the New Testament Gospel we locate its
origin in the Old Testament examining its relationship with the Law and
Temple, Priesthood and Prophets, observing its social implications, and we
follow it en route to the New Testament.
In chapter four we engage in a brief examination of the Hellenistic
cultural environment including the Jewish Diaspora, in order to have a
grasp of the initial interaction between Gospel and Culture.
Our concern in chapter five is to recover the essence of Jesus’
proclamation of the Gospel as witnessed to in the Synoptics. From this
go on to examine its transmission to the wider Hellenistic milieu,
concentrating on the Pauline and Johannine presentations.
Finally it is argued that the Gospel in its transmission across
cultures should be proclaimed, as far as possible, without cultural
accretions; that the prevailing categories and symbols understood within
the indigenous Jamaican culture be appreciated and, where possible,
appropriated for purposes of communication; and, fundamentally, that in
all circumstances the Church should faithfully guarantee a synchronization
between its message and action, and Jesus’ Gospel of the Kingdom of God,
described in terms of Good News to the Poor
