In the absence of mitral valve disease left atrial (LA) volume is a marker of diastolic dysfunction and its severity. This study investigated the relationship between left ventricular (LV) end diastolic pressure (LVEDP) and LA volumes and phasic atrial functions detected by real-time full volume three-dimensional echocardiography (RT3DE), in a patient population with preserved LV systolic function. Seventy-two (39 female and 33 male; mean age 56.1 ± 9.0 years) stable patients with normal LV ejection fraction (EF) undergoing cardiac catheterization were studied. All patients underwent comprehensive echocardiographic examination just before catheterization and LVEDP was obtained. In addition to conventional echocardiographic measurements and Doppler indices; by using RT3DE LA maximum, minimum and pre-a-wave volumes were measured; LA total, passive and active emptying volumes and fractions were calculated. LV systolic function was assessed by EF and global longitudinal strain by speckle tracking. RT3DE minimum LA volume index, RT3DE active LAEF and LA expansion index (EI) were statistically significant univariate predictors of LVEDP ≥ 16 mmHg. When age and hypertension adjusted multivariate analysis was performed EI [β = -1.741, p = 0.015; OR 0.175; 95 % CI (0.043-0.717)] was an independent predictor of elevated LVEDP. RT3DE evaluation of LA function during entire cardiac cycle has incremental value for the diagnosis of diastolic dysfunction in patients with preserved EF. We suggest that RT3DE evaluation of LA may find clinical application in this field.

It remains unclear whether immune-related adverse events (irAEs) and glucocorticoid use could impact long-term outcomes in patients treated for solid tumors with immune checkpoint inhibitors (ICI). All patients treated with a single-agent ICI for any advanced cancer were included in this retrospective unicentric study. The objectives were to assess the impact of grade ≥3 irAEs, glucocorticoid use and the interruption of immunotherapy on progression-free survival (PFS) and overall survival (OS). In this 828-patient cohort, the first occurrence of grade ≥3 irAEs had no significant impact on PFS or OS. Glucocorticoid administration for the irAEs was associated with a significantly shorter PFS (adjusted HR 3.0; p = 0.00040) and a trend toward shorter OS. ICI interruption was associated with a significantly shorter PFS (adjusted HR 3.5; p < 0.00043) and shorter OS (HR 4.5; p = 0.0027). Glucocorticoid administration and ICI interruption were correlated. In our population of patients treated with single agent ICI, grade ≥3 irAEs did not impact long-term outcomes. However, the need for glucocorticoids and the interruption of immunotherapy resulted in poorer long-term outcomes. The impact of grade ≥3 irAEs reported in other studies might then be explained by the management of the irAEs.

ÖzTip 1 diabetes mellitus (Tip 1 DM), tedavisinde beslenmenin önemli rol oynadığı, prevalansı gün geçtikçe artan metabolik bir bozukluktur. Öğün planları, öğün saatleri ve yasak yiyecek kavramı, diyabetli bireylerin zihnini sürekli meşgul edip vücut ağırlığı kontrolü üzerine düşünmelerine neden olabilmektedir. Bu durum özellikle Tip 1 DM'li kız adölesanlarda yeme davranışı bozukluğu insidansını artırabilmektedir. Oluşumunda genetik, biyolojik ve çevresel faktörlerin rol oynadığı düşünülen ve henüz DSM-V sınıflandırmasında yer almayan 'diyabulimia', Tip 1 DM'li bireylerin ağırlık kontrolünü sağlamak amacıyla insülin dozunu azaltması veya bilinçli olarak atlaması olarak tanımlanmaktadır. Diyabulimia, diyabete bağlı komplikasyon riskini ve mortalite oranını artırmakla birlikte geç puberteye, düzensiz menstrüasyon siklusuna, anksiyete problemlerine, depresif ataklara ve intihar girişimine neden olabilmektedir. Diyabulimia tedavisi diğer yeme davranışı bozukluklarında olduğu gibi alanında uzman doktor, psikiyatr, diyetisyen, hemşire ve psikoloğu içeren multidisipliner bir ekip çalışmasını gerektirmektedir. Tedavinin uzun sürmesi ve hastalığın tekrarlama riskinin son derece yüksek olması nedeniyle, bu konuda duyarlı olunması ve gelişiminin önlenmesi oldukça önemlidir. Diyabetliler arasında tanısı henüz konulamamış diyabulimia vakalarının olduğu tahmin edilmektedir. Bu nedenle derleme olarak hazırlanan bu makalede, diyabulimianın diyetisyen perspektifinden tedavisinin ve izleminin literatür ışığında tartışılması ve sağlık personelinin konu ile ilgili farkındalığının artırılması amaçlanmıştır.Anahtar sözcükler: Tip 1 diabetes mellitus, adölesan, diyabulimia, yeme davranışı bozukluğu Eating behavior disorder in individuals with type 1 diabetes mellitus: DiabulimiaAbstract Type 1 diabetes mellitus (Type 1 DM) is a metabolic disorder under which nutrition plays an important role in the management and the prevalence is increasing day by day. Meal plans, meal hours and the concept of forbidden food can cause diabetic individuals to constantly engage their minds and consider about the body weight control.

Aim: The effects of chronic aortic regurgitation (AR) on coronary TFC, 43±7.3 vs. 30±5.9 frames/s, p<0.001; Corrected LAD (cLAD) TFC, 25.0±4.3 vs. 17.6 ± 3.5 frames/s, p< 0.001; Left circumflex artery (LCx) TFC, 27.0±6.4 vs. 19.9±3.4 frames/s, p<0.001; and Right coronary artery (RCA) TFC, 25.8±5.5 vs. 19.9±4.7 frames/s, p<0.001; mean TFC, 26.3±5.4 vs.19.1±3.9 frames/s, p<0.001). Conclusion

Background: ICIs have dramatically improved patient outcomes in different malignancies. However, the impact of liver metastases (LM) and number of metastatic sites (MS) remains unclear in patients treated with single-agent anti-PD(L)1. Methods: We aimed to assess the prognostic impact of LM and MS number on progression-free survival (PFS) and overall survival (OS) in a large single-arm retrospective multicentric cohort (IMMUCARE) of patients treated with anti-PD(L)-1 for different solid tumors. Results: A total of 759 patients were enrolled from January 2012 to October 2018. The primary tumor types were non-small cell lung cancer (71%), melanoma (19%), or urologic cancer (10%). At the time of ICI initiation, 167 patients (22%) had LM and 370 patients (49%) had more than MS. LM was associated with a shorter median PFS of 1.9 months (95% CI: 1.8–2.5) vs. 4.0 months (95% CI: 3.6–5.4) in patients without LM (p < 0.001). The median OS of patients with LM was of 5.2 months (95% CI: 4.0–7.7) compared with 12.8 months (95% CI: 11.2–15.1) (p < 0.001). Interestingly, LM were not associated with shorter PFS, or OS compared to other MS types (brain, bone, or lung) in patients with only one MS. Patients with multiple MS also had poor clinical outcomes compared to patients with only one MS. The presence of LM and MS number were independent prognostic factors on overall survival. Conclusion: The presence of LM or multiple MS were associated with poorer survival outcomes in patients treated with anti-PD(L)-1.

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