A new strategy for the treatment of middle ear infection using ciprofloxacin/amoxicillin-loaded ethyl cellulose/polyhydroxybutyrate nanofibers

A middle ear infection occurs due to the presence of several microorganisms behind the eardrum (tympanic membrane) and is very challenging to treat due to its unique location and requires a well-designed treatment. If not treated properly, the infection can result in severe symptoms and unavoidable side effects. In this study, excellent biocompatible ethyl cellulose (EC) and biodegradable polyhydroxybutyrate (PHB) biopolymer were used to fabricate drug-loaded nanofiber scaffolds using an electrospinning technique to overcome antibiotic overdose and insufficient efficacy of drug release during treatment. PHB polymer was produced from Halomonas sp., and the purity of PHB was found to around be 90 %. Additionally, ciprofloxacin (CIP) and amoxicillin (AMX) are highly preferable since both drugs are highly effective against gram-negative and gram-positive bacteria to treat several infections. Obtained smooth nanofibers were between 116.24 and 171.82 nm in diameter and the addition of PHB polymer and antibiotics improved the morphology of the nanofiber scaffolds. Thermal properties of the nanofiber scaffolds were tested and the highest Tg temperature resulted at 229 °C. The mechanical properties of the scaffolds were tested, and the highest tensile strength resulted in 4.65 ± 6.33 MPa. Also, drug-loaded scaffolds were treated against the most common microorganisms that cause the infection, such as S.aureus, E.coli, and P.aeruginosa, and resulted in inhibition zones between 10 and 21 mm. MTT assay was performed by culturing human adipose-derived mesenchymal stem cells (hAD MSCs) on the scaffolds. The morphology of the hAD MSCs' attachment was tested with SEM analysis and hAD MSCs were able to attach, spread, and live on each scaffold even on the day of 7. The cumulative drug release kinetics of CIP and AMX from drug-loaded scaffolds were analysed in phosphate-buffered saline (pH: 7.4) within different time intervals of up to 14 days using a UV spectrophotometer. Furthermore, the drug release showed that the First-Order and Korsmeyer-Peppas models were the most suitable kinetic models. Animal testing was performed on SD rats, matrix and collagen deposition occurred on days 5 and 10, which were observed using Hematoxylin-eosin and Masson's trichrome staining. At the highest drug concentration, a better repair effect was observed. Results were promising and showed potential for novel treatment.

Three-Dimensional-Printed GelMA-KerMA Composite Patches as an Innovative Platform for Potential Tissue Engineering of Tympanic Membrane Perforations

Tympanic membrane (TM) perforations, primarily induced by middle ear infections, the introduction of foreign objects into the ear, and acoustic trauma, lead to hearing abnormalities and ear infections. We describe the design and fabrication of a novel composite patch containing photocrosslinkable gelatin methacryloyl (GelMA) and keratin methacryloyl (KerMA) hydrogels. GelMA-KerMA patches containing conical microneedles in their design were developed using the digital light processing (DLP) 3D printing approach. Following this, the patches were biofunctionalized by applying a coaxial coating with PVA nanoparticles loaded with gentamicin (GEN) and fibroblast growth factor (FGF-2) with the Electrohydrodynamic Atomization (EHDA) method. The developed nanoparticle-coated 3D-printed patches were evaluated in terms of their chemical, morphological, mechanical, swelling, and degradation behavior. In addition, the GEN and FGF-2 release profiles, antimicrobial properties, and biocompatibility of the patches were examined in vitro. The morphological assessment verified the successful fabrication and nanoparticle coating of the 3D-printed GelMA-KerMA patches. The outcomes of antibacterial tests demonstrated that GEN@PVA/GelMA-KerMA patches exhibited substantial antibacterial efficacy against Staphylococcus aureus, Pseudomonas aeruginosa, and Escherichia coli. Furthermore, cell culture studies revealed that GelMA-KerMA patches were biocompatible with human adipose-derived mesenchymal stem cells (hADMSC) and supported cell attachment and proliferation without any cytotoxicity. These findings indicated that biofunctional 3D-printed GelMA-KerMA patches have the potential to be a promising therapeutic approach for addressing TM perforations.

Single-Walled (Magnetic) Carbon Nanotubes in a Pectin Matrix in the Design of an Allantoin Delivery System

Single-walled carbon nanotubes (SWCNTs) outperform other materials due to their high conductivity, large specific surface area, and chemical resistance. They have numerous biomedical applications, including the magnetization of the SWCNT (mSWCNT). The drug loading and release properties of see-through pectin hydrogels doped with SWCNTs and mSWCNTs were evaluated in this study. The active molecule in the hydrogel structure is allantoin, and calcium chloride serves as a cross-linker. In addition to mixing, absorption, and swelling techniques, drug loading into carbon nanotubes was also been studied. To characterize the films, differential scanning calorimetry (DSC), thermal gravimetric analysis (TGA), Fourier transform infrared (FTIR) spectroscopy, surface contact angle measurements, and opacity analysis were carried out. Apart from these, a rheological analysis was also carried out to examine the flow properties of the hydrogels. The study was also expanded to include N-(9-fluorenyl methoxycarbonyl)glycine-coated SWCNTs and mSWCNTs as additives to evaluate the efficiency of the drug-loading approach. Although the CNT additive was used at a 1:1000 weight ratio, it had a significant impact on the hydrogel properties. This effect, which was first observed in the thermal properties, was confirmed in rheological analyses by increasing solution viscosity. Additionally, rheological analysis and drug release profiles show that the type of additive causes a change in the matrix structure. According to TGA findings, even though SWCNTs and mSWCNTs were not coated more than 5%, the coating had a significant effect on drug release control. In addition to all findings, cell viability tests revealed that hydrogels with various additives could be used for visual wound monitoring, hyperthermia treatment, and allantoin release in wound treatment applications.

Development of gallic acid-loaded ethylcellulose fibers as a potential wound dressing material

In this study, novel fibers were designed based on ethylcellulose (EC), loaded with different concentrations of gallic acid (GA) using the electrospinning technique, in order to investigate the potential of these materials as wound dressings. The chemical structure and morphology, along with the antimicrobial and biocompatibility tests of the EC_GA fibers were investigated. To observe the chemical interactions between the components, fourier transform infrared spectroscopy (FTIR) was used. The morphological analyzes were performed using scanning electron microscope (SEM). The uniaxial tensile test machine was used to obtain mechanical performance of the fibers. MTT assay was applied to get the biocompatibility properties of the fibers and antimicrobial test was applied to obtain the antimicrobial activity of the fibers. Based on the obtained results, the highest viability value of 67.4 % was obtained for 10%EC_100GA on the third day of incubation, demonstrating that with the addition of a higher concentration of GA, the cell viability increases. The antimicrobial tests, evaluated against Staphylococcus (S.) aureus, Escherichia (E.) coli, Pseudomonas (Ps.) aeruginosa and Candida (C.) albicans, showed a >90 % microbial reduction capacity correlated with a logarithmic reduction ranging from 0.63 to 1, for 10%EC_100 GA. In vitro release tests of GA from the fibers showed that GA was totally released from 10%EC_100 GA fibers after 2880 min, demonstrating a controlled release profile. These findings demonstrated that EC_GA fibers may be suitable for application in biomedical fields such as wound dressing materials. However, further studies should be performed to increase the biocompatibility properties of the fibers.

Elevated checkpoint inhibitor expression and Treg cell number in autosomal dominant polycystic kidney disease and their correlation with disease parameters and hypertension

Autosomal dominant polycystic kidney disease (ADPKD) has cancer-like pathophysiology. In this study, we aimed to investigate the phenotype of peripheral blood (PB) T cell subsets and immune checkpoint inhibitor expression of ADPKD patients across different chronic kidney disease (CKD) stages. Seventy-two patients with ADPKD and twenty-three healthy controls were included in the study. The patients were grouped into five different CKD stages, according to glomerular filtration rate (GFR). PB mononuclear cells were isolated and T cell subsets and cytokine production were examined by flow cytometry. CRP levels, height-adjusted total kidney volume (htTKV), rate of hypertension (HT) differed significantly across different GFR stages in ADPKD. T cell phenotyping revealed significantly elevated CD3+ T cells, CD4+, CD8+, double-negative, and double-positive subsets and significantly elevated IFN-γ and TNF-α producing subsets of CD4+, CD8+ cells. The expression of checkpoint inhibitors CTLA-4, PD-1, and TIGIT by T cell subsets was also increased to various extent. Additionally, Treg cell numbers and suppressive markers CTLA-4, PD-1, and TIGIT were significantly elevated in ADPKD patients' PB. Treg CTLA4 expression and CD4CD8DP T cell frequency in patients with HT were significantly higher. Lastly, HT and increased htTKV and higher frequency of PD1+ CD8SP were found to be risk factors for rapid disease progression. Our data provide the first detailed analyses of checkpoint inhibitor expression by PB T cell subsets during stages of ADPKD, and that a higher frequency of PD1+ CD8SP cells is associated with rapid disease progression.

Biocompatible polyvinyl alcohol nanofibers loaded with amoxicillin and salicylic acid to prevent wound infections

Diabetic wounds are one of the most challenging clinical conditions in diabetes, necessitating the development of new treatments to foster healing and prevent microbial contamination. In this study, polyvinyl alcohol was used as a matrix polymer, and amoxicillin (AMX) and salicylic acid (SA) were selected as bioactive compounds with antimicrobial (with AMX) and anti-inflammatory action (with SA) to obtain innovative drug-loaded electrospun nanofiber patches for the management of diabetic wounds. Scanning electron microscope images revealed the uniform and beadless structure of the nanofiber patches. Mechanical tests indicated that AMX minimally increased the tensile strength, while SA significantly reduced it. The patches demonstrated effective antibacterial activity against both gram-positive (Staphylococcus aureus) and gram-negative (Escherichia coli) strains. The potential of these patches in the development of novel wound dressings is highlighted by the excellent biocompatibility with fibroblast cells maintained for up to 7 d.

Treatment of systemic sclerosis-associated digital ulcers: recommendations of the Turkish Society for Rheumatology

OBJECTIVES

Digital ulcers (DUs) are associated with a significant burden in systemic sclerosis (SSc) by leading to severe pain, physical disability, and reduced quality of life. This effort aimed to develop recommendations of the Turkish Society for Rheumatology (TRD) on the management of DUs associated with SSc.

METHODS

In the first meeting held in December 2020 with the participation of a task force consisting of 23 rheumatologists the scope of the recommendations and research questions were determined. A systematic literature review was conducted by 5 fellows and results were presented to the task force during the second meeting. The Oxford system was used to determine the level of evidence. The preliminary recommendations were discussed, modified, and voted by the task force and then by members of TRD via e-mail invitation allowing personalised access to a web-based questionnaire [SurveyMonkey®].

RESULTS

A total of 23 recommendations under 7 main headings were formulated covering non-pharmacological measures for the prevention of DUs and pharmacological treatments including vasodilators, anti-aggregants, antibiotics, wound care, pain control, and interventions including sympathectomy, botulinum toxin, and surgery. Risk factors, poor prognostic factors, prevention of DU and adverse effects of medical treatments were reported as 4 overarching principles.

CONCLUSIONS

These evidence-based recommendations for the management of SSc-associated DUs were developed to provide a useful guide to all physicians who are involved in the care of patients with SSc, as well as to point out unmet needs in this field.

Prevalence of rectus diastasis is higher in patients with inguinal hernia

PURPOSE

To determine the prevalence of rectus diastasis (RD) in patients with inguinal hernia.

MATERIAL AND METHODS

Multicenter, cross-sectional study. Patients with inguinal hernia were included in the study group (IH) and those with benign proctologic complaints created the control group (CG). Age, gender, BMI, family history for inguinal hernias, comorbid diseases, alcohol use, smoking, constipation, malignancy, chemotherapy, number of births, multiple pregnancies and prostate hypertrophy history of all patients in both groups were recorded. All patients were evaluated for RD and umbilical hernias by physical examination.

RESULTS

A total of 528 consecutive patients were included in the study (292 IH / 236 CG). Overall prevalence of RD was 35.6% and it was significantly higher in IH than in CG (46.9% vs 21.6%, p < 0.001). Also, umbilical hernia was more frequently detected in the patients with inguinal hernia. Other risk factors for RD were age, BMI, DM, BPH and smoking. The mean inter-rectus distance for 528 patients was 18.1 mm; it was 20.71 ± 10.68 mm in IH and 14.88 ± 8.82 in CG (p < 0.001). It was determined that the increase in age and BMI caused an increase in the inter-rectus distance, and that the presence of DM, inguinal hernia and umbilical hernia increased the inter-rectus distance quantitatively.

CONCLUSIONS

The prevalence of RD seems to be higher in patients with inguinal hernia comparing to that in general population. Increased age, high BMI and DM were found to be independent risk factors for RD development.

Investigation of the antitumor effect on breast cancer cells of the electrospun amygdalin-loaded poly(l-lactic acid)/poly(ethylene glycol) nanofibers

In this study, PLA/PEG nanofibers (NFs) loaded with amygdalin (AMG) and bitter almond kernels extract were produced by electrospinning to prevent local breast cancer recurrence, and the effect of produced NFs on the MCF-7 cell line was investigated in vitro. The electrospun NFs were characterized by scanning electron microscopy (SEM), Fourier-transform infrared spectroscopy (FT-IR), thermal analysis (DSC) and tensile strength and physical analyzes were performed. Loading of AMG to nanofibers increased fiber diameters from 827.93 ± 174.507 nm to 1855.32 ± 291.057 μm. When drug release results were analyzed, the NFs showed a controlled release profile extending up to 10 h. The encapsulation efficiency of AMG-loaded NFs was calculated at 100 ± 0,01 %, 94 ± 0,02 %, and 88 ± 0,02 %. When in vitro cytotoxicity results were analyzed, showed that all NFs are effective in inducing cytotoxicity against MCF-7 breast cancer cells. Importantly, 20 mg AMG-loaded NFs displayed effectively higher cytotoxic effects against breast cancer cells relative to the other NFs. Considering all the results, AMG-loaded NFs can give sustained release of drugs at the local sites. Therefore, AMG-loaded nanofibers can reduce the risk of local recurrence of cancer after surgery and can be directly implanted into solid tumor cells for treatment.

Does onlay mesh placement in emergency laparotomy prevent incisional hernia? A prospective randomized double-blind study

PURPOSE

The objective of this study is to assess the effectiveness and safety of onlay mesh closure of emergency midline laparotomy to prevent incisional hernia.

METHODS

This is a prospective randomized double-blind study and was carried out in the General Surgery Clinic, Konya City Hospital, from August 1, 2020 to August, 1, 2021. The study included 108 patients who were randomly grouped in 2 groups: patients with conventional abdominal closure and closure using additional onlay mesh (1:1). The follow-up period was for a year. The primary outcome was the incidence of incisional hernia and secondary outcomes were clinical data like complications, hospital length of stay, re-operations.

RESULTS

It was observed that incisional hernia was present in 14 patients (27.4%) in conventional abdominal closure group and was in 2 patients using mesh (4%), (p = 0.001). Clavien-Dindo 3B complications were in rise in conventional closure group (p = 0.02). Of all complications, burst abdomen was significantly more common in conventional closure group (p = 0.04). The rate of surgically treated complications were higher in conventional closure group (p = 0.02). Clavien-Dindo 3A complications were more common in patients with contaminated wound in mesh group (p = 0.02).

CONCLUSION

The use of mesh while closing the abdomen in emergency midline laparotomy reduces the risk of incisional hernia. Thus, to lower the risks of incisional hernia and its complications, prophylactic mesh can be used in high-risk patients.

Electrically Triggered Quercetin Release from Polycaprolactone/Bismuth Ferrite Microfibrous Scaffold for Skeletal Muscle Tissue

Skeletal muscle tissue engineering presents a promising avenue to address the limitations pertaining to the regenerative potential of stem cells in case of injury or damage. The objective of this research was to evaluate the effects of utilizing novel microfibrous scaffolds, containing the compound quercetin (Q), on skeletal muscle regeneration. Morphological test results showed us that the combination of bismuth ferrite (BFO), polycaprolactone (PCL), and Q were bonded and well-ordered with each other, and a uniform microfibrous structure was obtained. Antimicrobial susceptibility testing of PCL/BFO/Q was conducted, and microbial reduction was found to be over 90% in the highest concentration of Q-loaded microfibrous scaffolds with the most inhibitory effect on S. aureus strains. Further, biocompatibility was investigated by performing MTT testing, fluorescence testing, and SEM imaging on mesenchymal stem cells (MSCs) to determine whether they could act as suitable microfibrous scaffolds for skeletal muscle tissue engineering. Incremental changes in the concentration of Q led to increased strength and strain, allowing muscles to withstand stretching during the healing process. In addition, electrically conductive microfibrous scaffolds enhanced the drug release capability by revealing that Q can be released significantly more quickly by applying the appropriate electric field, compared with conventional drug-release techniques. These findings suggest a possible use for PCL/BFO/Q microfibrous scaffolds in skeletal muscle regeneration by demonstrating that the combined action of both guidance biomaterials was more successful than Q itself acting alone.

Evaluation of the Relationship Between Preoperative and Postoperative Platelet Values and Amount of Blood Transfusion in Cases with Craniosinocytosis

AIM

This study aimed to demonstrate that decreased platelet count in patients with craniosynostosis increases the requirement for blood replacement, thus providing guidance to clinicians by revealing the time at which the platelet count decreases. Additionally, the relationship between the amount of blood transfusion and preoperative and postoperative platelet counts was evaluated.

MATERIAL AND METHODS

This study included 38 patients with craniosynostosis who underwent surgery between July 2017 and March 2019 in the Neurosurgery Department. The patients exhibited no cranial pathologies except craniosynostosis. All surgeries were performed by a single surgeon. The demographic data, anesthesia and surgical durations, preoperative complete blood count and bleeding time, intraoperative blood transfusion amount, and postoperative complete blood count and total blood transfusion amount of the patients were recorded.

RESULTS

The preoperative and postoperative changes and the timing of changes in hemoglobin and platelet counts, amount and timing of postoperative blood transfusion, and relationship between the amount and timing of blood replacement and preoperative and postoperative platelet counts were evaluated. The postoperative platelet counts tended to decrease after 12, 18, 24, and 36 h, and began increasing after 48 h. Although decreased platelet count did not lead to platelet replacement, it influenced the erythrocyte replacement requirement in the postoperative period.

CONCLUSION

Platelet count was associated with the amount of blood replacement. The platelet counts decreased within the first 48 h following surgery and tended to elevate thereafter; thus, clinicians should closely monitor these platelet counts within 48 h after surgery.

P-125 INCIDENCE OF DIASTASIS RECTI ABDOMINIS SEEMS TO BE HIGHER IN PATIENTS WITH INGUINAL HERNIAS

Aim

To find the incidence of Diastasis Recti Abdominis (DRA) in patients with inguinal hernias.

Materials and Methods

Prospective, multicenter, cross-sectional study. Patients with inguinal hernias constitues the study group (IH), and patients with proctological disorders in the control group (PC). Investigated parameters: age, gender, BMI, family history, systemic comorbidities, alcohol consumption, tobacco use, constipation, malignancies, chemotherapy, number of births, multiple pregnancies, prostate hypertrophy. The measurements were done at 3 cm above the umbilicus. Any separation ≥20 mm was accepted as DRA. The existence of paraumbilical hernia (PUH)was also recorded.

Results

36 female and 212 male patients with a mean age of 51.3± 1.4 in IH, whereas 137 women and 305 men with a mean age of 44.5±15.9 in PC. 48.0% of IH and 21.1% of PC were diagnosed with DRA (p=0.001). Incidences of PU were 16.5% and %5.2 respectively (p=0.01). BMI ≥25, chronic pulmonary disease, multiple pregnancies and prostatic enlargement were associated with DRA. Multivariate analysis revealed that inguinal hernia and multiple pregnancies were independent factors for DRA.

Conclusions

Incidences of DRA and PUH seem to be higher in patients with inguinal hernias in comparison with control subjects.

P-019 BIOELECTRIC IMPEDANCE ANALYSIS TO DETERMINE THE RISK FACTORS FOR INGUINAL HERNIA

Aim

To search the risk factors for inguinal hernia development by performing bioelectrical impedance analysis.

Material & Methods

Prospective, multicenter, cross-sectional study. Patients with inguinal hernias constitues the study group (IH), and patients who admitted with other surgical problems in the control group (SC). Age, gender, and BMI of the patients were recorded. Body composition measurements were done by bioelectrical impedance analysis. The relations between the obtained parameters and inguinal hernia were evaluated.

Results

9 female and 125 male patients with a mean age of 53.4± 15.4 in IH, whereas 44 women and 24 men with a mean age of 44.5±15.9 in (SC). There were statistically significant differences between two groups regarding BMI, total body fat, lean abdominal muscle mass, abdominal fat amount, and visceral fat rates. Male gender, low total body fat rate, low total body fat amount, low lean body mass rate, and low visceral fat rate were determined as risk factors for inguinal hernia in univariate analysis. Only low total body fat rate was found to be an independent risk factor.

Conclusions

Low total body fat rate is an independent risk factor for inguinal hernia development.

The Autoinflammatory Diseases Alliance Registry of monogenic autoinflammatory diseases

Objective

The present manuscript aims to describe an international, electronic-based, user-friendly and interoperable patient registry for monogenic autoinflammatory diseases (mAIDs), developed in the contest of the Autoinflammatory Diseases Alliance (AIDA) Network.

Methods

This is an electronic platform, based on the Research Electronic Data Capture (REDCap) tool, used for real-world data collection of demographics, clinical, laboratory, instrumental and socioeconomic data of mAIDs patients. The instrument has flexibility, may change over time based on new scientific acquisitions, and communicate potentially with other similar registries; security, data quality and data governance are corner stones of the platform.

Results

AIDA project will share knowledge and expertise on mAIDs. Since its start, 118 centers from 24 countries and 4 continents have joined the AIDA project. Fifty-nine centers have already obtained the approval from their local Ethics Committees. Currently, the platform counts 337 users (122 Principal Investigators, 210 Site Investigators, 2 Lead Investigators, and 3 data managers). The Registry collects baseline and follow-up data using 3,748 fields organized into 21 instruments, which include demographics, patient history, symptoms, trigger/risk factors, therapies, and healthcare information for mAIDs patients.

Conclusions

The AIDA mAIDs Registry, acts both as a research tool for future collaborative real-life studies on mAIDs and as a service to connect all the figures called to participate. On this basis, the registry is expected to play a pivotal role in generating new scientific evidence on this group of rare diseases, substantially improving the management of patients, and optimizing the impact on the healthcare system. NCT 05200715 available at https://clinicaltrials.gov.

Quality of life, disease activity and preferences for administration routes in rheumatoid arthritis: a multicentre, prospective, observational study

Objective

We aimed to evaluate quality of life (QoL), disease activity, compliance to treatment, patient and physician preferences for route of administration (RoA), status of health and pain in RA patients starting advanced treatments or needing a switch, and the factors associated with patient preferences.

Methods

A multicentre, prospective, observational and 1-year follow-up study was conducted, between 2015 and 2020, in adult RA patients using advanced treatments for the first time or needing a switch in their current treatments. All the data collected were entered into electronic case report forms. DAS in 28 joints with ESR [DAS28-4(ESR)], EuroQol 5-Dimensional Questionnaire (EQ-5D), HAQ Disability Index (HAQ-DI), Compliance Questionnaire for Rheumatology (CQR-19), Work Productivity and Activity Impairment Instrument (WPAI) and Patient Global Assessment-Visual Analogue Scale (PGA-VAS) questionnaires were used for longitudinal assessments.

Results

Four hundred and fifty-nine patients were enrolled. Three hundred and eight patients (67.1%) attended the final study visit at 12 months and were included for comparative analyses. Irrespective of RoA, the disease activity and QoL improved significantly at 12 months, whereas compliance worsened. At baseline and 12 months, EQ-5D and DAS28-4(ESR) scores were significantly correlated (P < 0.001). The WPAI scores changed significantly in favour of better outcomes over 12 months after initiation of advanced treatment or switching (P < 0.001). A higher proportion of patients preferred an oral RoA, in comparison to physicians (53.6% vs 31.4%; P < 0.001). Patient and physician RoA preferences were independent of gender, age, disease duration, advanced treatment type and the EQ-5D-3L, DAS28-4(ESR), HAQ-DI, PGA-VAS and CQR-19 scores at baseline.

Conclusion

The oral route was more frequently preferred by patients compared with physicians, although patients’ preference rates showed a slight increase towards the end of the treatment, which might be an important factor for RA outcomes. Better control of disease activity and QoL were achieved at 12 months, regardless of RoA.

3D-Printed PCL Scaffolds Combined with Juglone for Skin Tissue Engineering

Skin diseases are commonly treated with antihistamines, antibiotics, laser therapy, topical medications, local vitamins, or steroids. Since conventional treatments for wound healing (skin allografts, amnion, xenografts, etc.) have disadvantages such as antigenicity of the donor tissue, risk of infection, or lack of basement membrane, skin tissue engineering has become a popular new approach. The current study presents the design and fabrication of a new wound-dressing material by the addition of Juglone (5-hydroxy-1,4-naphthoquinone) to a 25% Polycaprolactone (PCL) scaffold. Juglone (J) is a significant allelochemical found in walnut trees and, in this study is used as a bioactive material. The effects of different amounts of J (1.25, 2.5, 5, 7.5, and 10 mg) on the biocompatibility, mechanical, chemical, thermal, morphological, and antimicrobial properties of the 3D-printed 25% PCL scaffolds were investigated. The addition of J increased the pore diameter of the 25% PCL scaffold. The maximum pore size (290.72 ± 14 µm) was observed for the highest amount of J (10 mg). The biocompatibility tests on the scaffolds demonstrated biocompatible behavior from the first day of incubation, the 25% PCL/7.5 J scaffold having the highest viability value (118%) among all of the J-loaded scaffolds. Drug release of J into phosphate buffered saline (PBS) at pH 7.4 showed that J was completely released from all 25% PCL/J scaffolds within 7 days of incubation.

Assessment of semaphorin 3A and semaphorin 7A levels in primary Sjogren's syndrome

Sjogren's syndrome (SS) is a chronic autoimmune connective tissue disease. Varying rates of system involvements may be seen in the course of the disease. Semaphorins has multifunctions in several physiological and pathological processes such as immune system regulation. The association of Semaphorin 3A (Sema3A) and Semaphorin 7A (Sema7A), which are immune semaphorins, with autoimmune diseases is interesting for researchers. We aimed to compare serum Sema3A and Sema7A levels between primary SS and control subjects, and investigated Sema3A and Sema7A levels in disease subgroups and associated system involvements. 50 consecutive primary SS patients and 40 healthy subjects followed in the Rheumatology clinic of Cumhuriyet University Medical Faculty between 2017 and 2018 were included in the study. Inclusion criteria of patients were diagnosis of primary SS according to the 2016 ACR/EULAR classification criteria. Serum Sema3A and Sema7A levels were measured by commercial ELISA kit. Both groups were similar in terms of age, gender, and body mass index. Serum Sema3A and Sema7A levels were significantly lower in SS than in the controls (p = 0.001 and p = 0.005, respectively). Serum Sema3A levels were significantly lower in patients with renal involvement than in patients without (p = 0.03). Sema3A and Sema7A may play a role in the etiopathogenesis of SS and may be a potential serological marker for the diagnosis of SS and may be a target for treatment.

Development and Implementation of the AIDA International Registry for Patients With VEXAS Syndrome

Objective

The aim of this paper is to present the AutoInflammatory Disease Alliance (AIDA) international Registry dedicated to Vacuoles, E1 enzyme, X-linked, Autoinflammatory, Somatic (VEXAS) syndrome, describing its design, construction, and modalities of dissemination.

Methods

This Registry is a clinical, physician-driven, population- and electronic-based instrument designed for the retrospective and prospective collection of real-life data. Data gathering is based on the Research Electronic Data Capture (REDCap) tool and is intended to obtain real-world evidence for daily patients' management. The Registry may potentially communicate with other on-line tools dedicated to VEXAS syndrome, thus enhancing international collaboration and data sharing for research purposes. The Registry is practical enough to be easily modified to meet future needs regarding VEXAS syndrome.

Results

To date (April 22^nd, 2022), 113 Centers from 23 Countries in 4 continents have been involved; 324 users (114 Principal Investigators, 205 Site Investigators, 2 Lead Investigators, and 3 data managers) are currently able to access the registry for data entry (or data sharing) and collection. The Registry includes 4,952 fields organized into 18 instruments designed to fully describe patient's details about demographics, clinical manifestations, symptoms, histologic details about skin and bone marrow biopsies and aspirate, laboratory features, complications, comorbidities, therapies, and healthcare access.

Conclusion

This international Registry for patients with VEXAS syndrome will allow the achievement of a comprehensive knowledge about this new disease, with the final goal to obtain real-world evidence for daily clinical practice, especially in relation to the comprehension of this disease about the natural history and the possible therapeutic approaches. This Project can be found on https://clinicaltrials.gov NCT05200715.

AB1387 THE EFFECTS OF PREGNANCY AND FERTILITY ON DRUG USAGE AND PREFERENCES IN RHEUMATOLOGICAL DISEASES: A SINGLE CENTER EXPERIENCE

Background

Rheumatological diseases usually affect women of reproductive age. Although the effects of these diseases on pregnancy vary; Joint and organ damage that may occur should be prevented, maternal and fetal effects of the treatment should be evaluated (1).

Objectives

The aim of this study to determine the effects of rheumatological diseases and drugs used on pregnancy and fertility.

Methods

Between January 2014 and January 2021, women between the ages of 18-45 who were diagnosed and treated at Cumhuriyet University Medical Faculty Rheumatology-Internal Medicine Department were retrospectively analyzed.

Results

The median age of the patients is 37 (min 19-max 45) years. 517 patients (51,7%) were pregnant after diagnosis, 39 patients (3,9%) had abortion after diagnosis, 957 patients (95,7%) had live birth, 69 patients (6,9%) had curettage, 43 patients (4,3%) could not have children. The median of pregnancies before diagnosis is 2 (min 1-max 11) the median of pregnancies after diagnosis is 1 (min 1-max 6) the median of abortions before diagnosis is 2 (min 1-max 7) the median of abortions after diagnosis is 1 (min. 1-max 4) the median of curettage is 1 (min 1-max 3) the median of live births is 2 (min 1-max 5). The distribution of patients according to drug use and drug used during pregnancy is shown in Figure 1. The distribution of the patients according to the diagnosis and the factors affecting pregnancies after diagnosis, abortions after diagnosis, curettage and live birth is shown in Table 1.

Table 1.

The distribution of the patients according to the diagnosis and the factors affecting pregnancies after diagnosis, abortions after diagnosis, curettage and live birth.

†FMF‡RA¶AS§PSASarcoidosisGranulomatous MastitisMyositisVasculitisBehçet’s DiseaseStill’s SyndromeGoutFibromyalgia††SLESjögren’s SyndromeSystemic Sclerosis‡‡APSAvaliable (%n)224 %22.4197 %19.7274 %27,459 %5,91 %0,1117 %0,7169 %16,93 %0,32146 %14,6105 %10,56037 %3,729 %2,9%0,1%0,1%0,2%6Not Avaliable (%n)776803 %80,3726 %72,6941 %94,1999 %99,9999 %99,9999 %99,9993 %99,3831 %83,1997 %99,7998 %99,8854 %99,9895 %89,5940 %94963 %96,3971 %97,1%77,6Total (%n)1000 %1001000 %1001000 %1001000 %1001000 %1001000 %1001000 %1001000 %1001000 %1001000 %1001000 %1001000 %1001000 %1001000 %1001000 %1001000 %100Use of colchicineUse of anakinraUse of methorexateUse of leflunomide(*OR %95 confidence range)(*OR %95 confidence range)(*OR %95 confidence range)(*OR %95 confidence range)**p value**p value**p value**p valueNumber of pregnancy after diagnosis*OR:1,58 (1,22-2,034)*OR:6,69 (1,51-29,60)*OR: - 0,73 (0,51-0,93)*OR: - 0,53 (0,30-0,93)**p: ‹0,001**p: ‹0,004**p: 0,05**p: 0,035‡‡APS (*OR %95 confidence range)††SLE (*OR %95 confidence range)**p value**p valueNumber of abortion*OR: 3,7 (1,68-8,43)*OR: 7,5 (2,78-20,25)after diagnosis**p: ‹0,001**p: 0,001‡‡APS (*OR %95 confidence range)**p valueNumber of curettage*OR: 5,5 (1,94-15,84) **p: 0,001Number of live birth*OR: - 0,20 (0,05-0,75) **p: 0,017

*OR: Odds Ratio

**p‹0,05 significant

†FMF: Family Mediterranean Fever

‡RA: Rheumatoid Arthritis

¶AS: Ankylosing Spondylitis

§PSA: Psoriatic Arthritis

††SLE: Systemic Lupus Erythematosus

‡‡APS: Anti Phospholipid Syndrome

Figure 1.

Distribution of patients according to drug use and drugs used during pregnancy

Conclusion

Women with rheumatic diseases should be in remission before pregnancy and should be followed closely throughout their pregnancy and treated with pregnancy-safe drugs. Preparations that can cause infertility in women during the reproductive period should not be used as much as possible. Patients should be informed in detail about the effects of their disease and the drugs used on pregnancy.

References

[1]Peterson E. A., Lynton J., Bernard A., Santillan M. K., Bettendorf B., Rheumatologic Medication Use During Pregnancy, Obstetrics & Gynecology: May 2020 - Volume 135 - Issue 5 - p 1161-1176doi: 10.1097/AOG.0000000000003755.

Acknowledgements

We would like to thank to Biostatistics Faculty Member Dr. Ziynet Çinar.

Disclosure of Interests

None declared

Fabrication of Electrospun Juglans regia (Juglone) Loaded Poly(lactic acid) Scaffolds as a Potential Wound Dressing Material

Juglone (5-hydroxy-1,4-naphthoquinone) (J) is a naphthoquinone structured allelochemical that is mostly found in the roots, leaves, nut-hulls, bark, and wood of walnut (Juglans regia). In this study, the biocompatibility, mechanical, thermal, chemical, morphological, and antimicrobial properties of the poly(lactic acid) (PLA) (w/v)/J (10, 20, 30 mg) electrospun scaffolds were investigated. Based on the results of the study, it was shown that juglone addition increased the antimicrobial properties of the scaffolds against the Staphylococcus aureus (S. aureus) and Escherichia coli (E. coli), compared to the neat PLA film after 24 h of contact time. According to the tensile test results, the addition of J made the scaffolds more flexible but decreased the mechanical strength. The cytotoxicity properties of the J-added scaffolds demonstrated a toxic behavior on the first day of incubation. However, with an increase in the J ratio, the fibroblast cell metabolic activity increased for all incubation periods.

Combination of second-generation proteasome inhibitor Carfilzomib with Bortezomib in four different breast cancer cell lines

BACKGROUND

Proteasome inhibitors target different pathways in cells and therefore are promising drugs in cancer therapy. The use of these inhibitors is approved mainly in hematological cancers, and recently many clinical trials and preclinical studies are running for efficacy in solid tumors. Carfilzomib is a second generation inhibitor and developed to decrease the side effects of bortezomib. Although there are many valid therapies in breast cancer, resistance and recurrence are inevitable in many cases and the proteasomal system plays an important roles in related pathways.

OBJECTIVE

This study is a preliminary work to evaluate the combination effects of bortezomib and carfilzomib in four different breast cancer cells.

METHODS

MDA-MB-231, MCF-7, UACC-2087, and SKBR-3 cell lines were used. Cell viability was determined by using bortezomib and carfilzomib alone and in combination. Combination effect values were determined using the Chou-Talalay method. Apoptosis, proteasome activity, cleaved PARP, and HSP70 expressions were analyzed in the determined doses.

RESULTS

The response to the combination of the two inhibitors was different in four cell lines. Apoptosis was significantly higher in combination groups compared to carfilzomib in three cell lines except SKBR-3, and higher in combination group compared to bortezomib only in UACC-2087. Combination decreased cleaved PARP levels in MDA-MB-231 and MCF-7 and increased in SKBR-3 compared to bortezomib. HSP70 levels decreased in combination with UACC-2087 and SKBR-3 compared to carfilzomib.

CONCLUSION

Taken together, the combination of the two inhibitors was more apoptotic compared to carfilzomib and apoptosis was higher only in UACC-2087 compared to bortezomib. This apoptosis data can not be directly correlated to degree of proteaasome inhibiton, PARP cleavage and HSP70 response.

Dual Spinneret Electrospun Polyurethane/PVA-Gelatin Nanofibrous Scaffolds Containing Cinnamon Essential Oil and Nanoceria for Chronic Diabetic Wound Healing: Preparation, Physicochemical Characterization and In-Vitro Evaluation

In this study, a dual spinneret electrospinning technique was applied to fabricate a series of polyurethane (PU) and polyvinyl alcohol-gelatin (PVA/Gel) nanofibrous scaffolds. The study aims to enhance the properties of PU/PVA-Gel NFs loaded with a low dose of nanoceria through the incorporation of cinnamon essential oil (CEO). The as-prepared nCeO2 were embedded into the PVA/Gel nanofibrous layer, where the cinnamon essential oil (CEO) was incorporated into the PU nanofibrous layer. The morphology, thermal stability, mechanical properties, and chemical composition of the produced NF mats were investigated by STEM, DSC, and FTIR. The obtained results showed improvement in the mechanical, and thermal stability of the dual-fiber scaffolds by adding CEO along with nanoceria. The cytotoxicity evaluation revealed that the incorporation of CEO to PU/PVA-Gel loaded with a low dose of nanoceria could enhance the cell population compared to using pure PU/PVA-Gel NFs. Moreover, the presence of CEO could inhibit the growth rate of S. aureus more than E. coli. To our knowledge, this is the first time such nanofibrous membranes composed of PU and PVA-Gel have been produced. The first time was to load the nanofibrous membranes with both CEO and nCeO2. The obtained results indicate that the proposed PU/PVA-Gel NFs represent promising platforms with CEO and nCeO2 for effectively managing diabetic wounds.

Investigation of 3D-Printed Polycaprolactone-/Polyvinylpyrrolidone-Based Constructs

The aim of this study is to evaluate the mechanical and biological performance of cartilage-like constructs produced by 3D printing. During the investigation, poly(ε-caprolactone) (PCL) and polyvinylpyrrolidone (PVP) were used as a matrix polymer and low-molecular-weight chitosan (CS), hyaluronic acid (HA), and alginic acid sodium salt (SA) were integrated separately with the polymer matrix to fabricate the constructs. Thermal, mechanical, morphology, and chemical properties and swelling, degradation, and biocompatibility behaviors were evaluated in detail. With the addition of 3 fillers, the melting temperature of the matrix increased with the addition of fillers, and PCL/3wt.%PVP/1wt.%HA had the highest melting temperature value. Mechanical characterization results demonstrated that the printed PCL/3wt.%PVP/1wt.%CS displayed the highest compressive strength of around 9.51 MPa. The compressive strength difference between the PCL/3wt.%PVP and PCL/3wt.%PVP/1wt.%CS was 5.38 MPa. Biocompatibility properties of the constructs were tested by mitochondrial dehydrogenase activity, and in vitro studies showed that the PCL/3wt.%PVP/1wt.%HA composite construct had more cell viability than the other constructs by making use of the mesenchymal stem cell line.

Study of Aqueous Ecballium Elaterium as Fibrinolytic in The Rabbit Model of Intrapleural Empyema

Aims

We aimed to investigate of intrapleural use of ecballium elaterium (EE) in a rabbit model empyema.

Methods

An empyema was induced in 21 rabbits after inoculation of Staphylococcus aureus. Glucose levels, pH, lactate dehydrogenase levels, and amounts of pleural drainage were evaluated in addition to pleural and empyema scores. The rabbits were divided into three groups, each 7, the isotonic solution, the streptokinase, and the ecballium group.

Results

At autopsy, there was no difference in pH, glucose, and LDH levels in three groups. The mean pleural drainage was greater in the ecballium group. A significant difference was detected between groups in terms of drainage amounts and pleural and empyema scores (P < 0.05). A significant difference in pleural and empyema scores was detected in the ecballium and streptokinase groups (P < 0.05). EE group had significant differences in drainage amounts and plural and empyema scores regard to the control group (P < 0.05). No significance was found between streptokinase and EE groups.

Conclusion

We conclude that intrapleural use of EE is at least as effective as streptokinase for the treatment of empyema.

The opioid peptide biphalin modulates human corneal epithelial wound healing in vitro

PURPOSE

Analgesic drugs, including nonselective opioids and non-steroidal anti-inflammatory drugs, should be used with great precautions to relieve pain after trauma to the corneal epithelium because of their unfavorable effects on wound healing. Biphalin is a synthetic opioid peptide that has been demonstrated to possess a strong analgesic effect on rodents. The purpose of this study is to investigate the effects of biphalin on human corneal epithelial wound healing.

METHODS

An immortalized human corneal epithelial cell (HCEC) culture was used to analyze the effects of biphalin on wound healing. The toxicity of biphalin at various concentrations was measured by the MTT assay. The effects of 1μM and 10μM biphalin on wound closure, cell migration and proliferation were tested in an in vitro scratch assay of HCECs. Naloxone, a non-selective competitive opioid receptor antagonist, was also used to inhibit the effects of biphalin in all experiments.

RESULTS

Biphalin did not cause any toxic effect on HCECs at concentrations lower than 100μM at various incubation time points. Biphalin significantly increased wound healing at 1μM concentration in an in vitro scratch assay of HCECs (P<0.05). It also significantly increased migration of HCECs (P<0.01). There was no significant difference between the biphalin and control groups of HCECs in the Ki67 proliferation assay.

CONCLUSION

Biphalin, which is a synthetic opioid peptide, promotes corneal epithelial wound healing by increasing cell migration. This role should be evaluated in further in vivo and clinical studies.

Chitosan/Gold Hybrid Nanoparticles Enriched Electrospun PVA Nanofibrous Mats for the Topical Delivery of Punica granatum L. Extract: Synthesis, Characterization, Biocompatibility and Antibacterial Properties

Purpose

Intending to obtain Punica granatum L. extract (PE)-loaded drug delivery system of better impact and biomedical applicability, the current study reports the use of crosslinked PVA nanofibers (NFs) as platforms incorporating different amounts of biosynthesized PE-CS-gold nanoparticles (PE-CS-Au NPs).

Methods

PE-conjugated CS-Au nanoparticles (PE-CS-Au NPs) were synthesized via green chemistry approach. The formation of PE-CS-Au NPs was confirmed by UV spectroscopy, DLS, SEM and STEM. PE-CS-Au NPs were then dispersed into polyvinyl alcohol (PVA) solution at different ratios, where the optimized ratios were selected for electrospinning and further studies. Crosslinking of PE-CS-Au NPs loaded PVA nanofibers (NFs) was performed via glutaraldehyde vapor. The morphology, chemical compositions, thermal stability and mechanical properties of PE-CS-Au NPs loaded NFs were evaluated by SEM, FTIR and DSC. Swelling capacity, biodegradability, PE release profiles, release kinetics, antibacterial and cell biocompatibility were also demonstrated.

Results

By incorporating PE-CS-Au NPs at 0.6% and 0.9%, the diameters of the nanofibers decreased from 295.7±83.1 nm in neat PVA to 165.6±43.4 and 147.8±42.7 nm, respectively. It is worth noting that crosslinking and incorporation of PE-CS-Au NPs improved thermal stability and mechanical properties of the obtained NFs. The release of PE from NFs was controlled by a Fickian diffusion mechanism (n value ˂0.5), whereas Higuchi was the mathematical model which could describe this release. The antibacterial activity was found to be directly proportional to the amount of the incorporated PE-CS-Au NPs. The human fibroblasts (HFF-1) showed the highest viability (123%) by seeding over the PVA NFs mats containing 0.9% PE-CS-Au NPs.

Conclusion

The obtained results suggest that the electrospun PVA NFs composites containing 0.9% PE-CS-Au NPs can be used as antibacterial agents against antibiotic-resistant bacteria, and as suitable scaffolds for cell adhesion, growth and proliferation of fibroblast populations.

The Spectrum of Underlying Diseases in Children with Torticollis

AIM

To investigate the underlying conditions in children with torticollis.

MATERIAL AND METHODS

Between May 2016 and December 2019, 24 patients (10 girls and 14 boys; mean age, 8 years) presenting with twisted neck, neck pain, weakness of extremities, imbalance, and gait disorder were evaluated retrospectively.

RESULTS

Five of the patients had cranial pathologies (cerebellar anaplastic ependymoma and medulloblastoma, brain stem glioma, atypical teratoid rhabdoid tumor, and acute disseminated encephalomyelitis), and five of the patients had spinal pathologies (idiopathic intervertebral disc calcification, vertebral hemangiomatosis, compression fracture, multiple hereditary exostoses, and Langerhans cell histiocytosis at C4). Six of the patients had ocular pathologies (strabismus, Duane syndrome, and Brown syndrome each in two patients). Four patients had otorhinolaryngological infections (Sandifer syndrome, esophageal atresia, reflux, and spasmus nutans, with one patient each). Detailed clinical physical examination and necessary laboratory investigation were performed for all patients.

CONCLUSION

Torticollis is a sign that is not always innocent and may herald an underlying severe disease. Misdiagnosis can lead to wrong and unnecessary surgical procedures and treatments, and sometimes, the results can be damaging due to underlying severe conditions if diagnosed late. In addition, we first report a case of vertebral hemangiomatosis and temporomandibular joint ankylosis that presented with torticollis in the English medical literature.

Dual-drug delivery of Ag-chitosan nanoparticles and phenytoin via core-shell PVA/PCL electrospun nanofibers

Dual-drug delivery systems were constructed through coaxial techniques, which were convenient for the model drugs used the present work. This study aimed to fabricate core-shell electrospun nanofibrous membranes displaying simultaneous cell proliferation and antibacterial activity. For that purpose, phenytoin (Ph), a well-known proliferative agent, was loaded into a polycaprolactone (PCL) shell membrane, and as-prepared silver-chitosan nanoparticles (Ag-CS NPs), as biocidal agents, were embedded in a polyvinyl alcohol (PVA) core layer. The morphology, chemical composition, mechanical and thermal properties of the nanofibrous membranes were characterized by FESEM/STEM, FTIR and DSC. The coaxial PVA-Ag CS NPs/PCL-Ph nanofibers (NFs) showed more controlled Ph release than PVA/PCL-Ph NFs. There was notable improvement in the morphology, thermal, mechanical, antibacterial properties and cytobiocompatibility of the fibers upon incorporation of Ph and Ag-CS NPs. The proposed core-shell PVA/PCL NFs represent promising scaffolds for tissue regeneration and wound healing by the effective dual delivery of phenytoin and Ag-CS NPs.

Electrically Triggered Drug Delivery from Novel Electrospun Poly(Lactic Acid)/Graphene Oxide/Quercetin Fibrous Scaffolds for Wound Dressing Applications

The novel controlled and localized delivery of drug molecules to target tissues using an external electric stimulus makes electro-responsive drug delivery systems both feasible and desirable, as well as entailing a reduction in the side effects. Novel micro-scaffold matrices were designed based on poly(lactic acid) (PLA) and graphene oxide (GO) via electrospinning. Quercetin (Q), a natural flavonoid, was loaded into the fiber matrices in order to investigate the potential as a model drug for wound dressing applications. The physico-chemical properties, electrical triggering capacity, antimicrobial assay and biocompatibility were also investigated. The newly fabricated PLA/GO/Q scaffolds showed uniform and smooth surface morphologies, without any beads, and with diameters ranging from 1107 nm (10%PLA/0.1GO/Q) to 1243 nm (10%PLA). The in vitro release tests of Q from the scaffolds showed that Q can be released much faster (up to 8640 times) when an appropriate electric field is applied compared to traditional drug-release approaches. For instance, 10 s of electric stimulation is enough to ensure the full delivery of the loaded Q from the 10%PLA/1%GO/Q microfiber scaffold at both 10 Hz and at 50 Hz. The antimicrobial tests showed the inhibition of bacterial film growth. Certainly, these materials could be loaded with more potent agents for anti-cancer, anti-infection, and anti-osteoporotic therapies. The L929 fibroblast cells cultured on these scaffolds were distributed homogeneously on the scaffolds, and the highest viability value of 82.3% was obtained for the 10%PLA/0.5%GO/Q microfiber scaffold. Moreover, the addition of Q in the PLA/GO matrix stimulated the production of IL-6 at 24 h, which could be linked to an acute inflammatory response in the exposed fibroblast cells, as a potential effect of wound healing. As a general conclusion, these results demonstrate the possibility of developing graphene oxide-based supports for the electrically triggered delivery of biological active agents, with the delivery rate being externally controlled in order to ensure personalized release.

AB0893-HPR TREATMENT SATISFACTION, EXPECTATIONS, PATIENT PREFERENCES, AND CHARACTERISTICS IN PATIENTS WITH RHEUMATOID ARTHRITIS (RA): TURKISH COHORT RESULTS OF THE SENSE STUDY

Background:

Suboptimal control of RA may lead to severe and progressive articular damage, loss of function, and deterioration of the quality of life (QoL).

Objectives:

To assess treatment satisfaction, sociodemographic, clinical, health care resource utilization, and QoL characteristics of patients with sub-optimally controlled RA and treated with conventional synthetic and/or biologic DMARDs.

Methods:

This study was an international, multicenter, cross-sectional, non-interventional study. Adult RA patients with moderate to severe disease activity (DAS28>3.2) were enrolled. Patient satisfaction was evaluated with Treatment Satisfaction Questionnaire for Medication (TSQM, version 1.4) with a scale ranging from 0 (indicating poor satisfaction) to 100 (indicating perfect satisfaction). Patients were questioned regarding treatment adherence, patient preferences, and expectations. Workability was evaluated using Work Productivity and Activity Impairment Questionnaire-Rheumatoid Arthritis (WPAI-RA, version 2.0). Short Form 36 (V2) survey were performed to all patients.

Results:

One hundred sixty-four patients were included in the study and most (78.0%) were female. The median age was 57.0 years, ranging between 22.0 and 84.0 years. Half of the patients (50.6%) were primary school graduates and 6.1% were unemployed due to RA and seeking work. Median time since RA diagnosis was 8.0 years and mean (±SD) DAS28-CRP score was 4.8 (±1.0). Mean total activity impairment was 54.9% (±27.4). In the past 3 months from enrollment, the mean number of healthcare professional and emergency room visits were 1.8 (±1.1) and 1.8 (±1.3), respectively. Mean number and length of hospitalizations in the previous 3 months were 1.1 (±0.3) times and 8.3 (±7.2) days, respectively. Mean TSQM scores were 53.5 (±21.4) for effectiveness, 86.0 (±26.7) for side effects, 67.8 (±16.5) for convenience, and 57.7 (±22.0) for global satisfaction. The leading expectation was ‘lasting relief of RA symptoms’ (mean score: 5.8). Preferred time until the effect of onset was ‘up to 1 week’ for 76.2% of the patients. Most of the patients (57.9%) preferred oral administrations and the most preferred frequency of administration was ‘once per day’ (46.3%). Mean physical and mental component summary scores for Short Form 36 (V2) survey were 37.9 (±8.3) and 40.1 (±10.7).

Conclusion:

Two-thirds of the patients with RA who have suboptimal responses are not satisfied with their treatments. Moreover, oral and once-daily treatment approaches stand out in patient preferences. Finally, suboptimal control leads to deterioration in clinical characteristics, workability, and QoL of patients with RA.

Acknowledgements:

The design, study conduct, and financial support for the study were provided by AbbVie. AbbVie participated in the interpretation of data, review, and approval of the publication. All authors have received research funding for this study. The authors wish to thank B. Murat Ozdemir of Monitor CRO for medical editing and reviewing services of this manuscript. AbbVie provided funding to Monitor CRO for this work.

Disclosure of Interests:

Umut Kalyoncu Speakers bureau: AbbVie, Pfizer, UCB, Novartis, and Janssen, Consultant of: AbbVie, Pfizer, UCB, Novartis, and Lilly, Grant/research support from: AbbVie, Pfizer, and Janssen, Adem Kucuk Speakers bureau: AbbVie, Gokhan Sargin: None declared, Fatih Ozdener Speakers bureau: UCB, Nutricia Advanced Medical Nutrition, Grant/research support from: Nutricia Advanced Medical Nutrition, Servet Yolbaş Speakers bureau: AbbVie, UCB, Pfizer, and MSD, Berna Yurttas: None declared, Sezin Turan: None declared, Gezmiş Kimyon Speakers bureau: AbbVie, Amgen, Pfizer, Novartis, UCB, MSD, Johnson and Johnson, and Celltrion, Consultant of: Amgen, and Pfizer, ALI SAHIN Speakers bureau: Roche, Pfizer, and AbbVie, Consultant of: Roche and Pfizer, Sedat Yilmaz Speakers bureau: UCB, Pfizer, AbbVie, MSD, Novartis, and Celltrion, Consultant of: Pfizer and Novartis, Ridvan Mercan Speakers bureau: AbbVie, Novartis, MSD, Pfizer, UCB, Roche, Amgen, and Celltrion, Consultant of: Novartis, MSD, Pfizer, and Celltrion, Hakan Emmungil Speakers bureau: AbbVie, Pfizer, Novartis, and MSD, Muhammet Çinar Speakers bureau: AbbVie, Pfizer, Celltrion, UCB, Amgen, Novartis, and MSD, Grant/research support from: AbbVie, Pfizer, Celltrion, UCB, Amgen, Novartis, and MSD, İlhan Sezer Speakers bureau: AbbVie, Pfizer, MSD, Novartis, Celltrion, UCB, Amgen, and Abdi Ibrahim, Consultant of: AbbVie, Pfizer, MSD, Novartis, Celltrion, UCB, Amgen, and Abdi Ibrahim, Grant/research support from: AbbVie, Pfizer, MSD, Novartis, Celltrion, UCB, Amgen, and Abdi Ibrahim, Timuçin Kaşifoğlu Speakers bureau: AbbVie, Amgen, Roche, MSD, Novartis, Pfizer, and UCB, Consultant of: AbbVie, Amgen, Roche, MSD, Novartis, Pfizer, and UCB, Fulya Cosan Speakers bureau: AbbVie, Pfizer, Novartis, UCB, and MSD, Taskin Senturk: None declared, Nevsun Inanc Speakers bureau: AbbVie, UCB, Novartis, Pfizer, Roche, Lilly and MSD, Consultant of: Roche and Pfizer, Grant/research support from: Roche and Pfizer

alpha-Tocopherol supplementation reduces inflammation and apoptosis in high cholesterol mediated nonalcoholic steatohepatitis

Inflammation and apoptosis signaling are crucial steps in the progression from nonalcoholic fatty liver disease (NAFLD) to nonalcoholic steatohepatitis (NASH). Alpha-tocopherol, the most active form of vitamin E, is an important modulator of signaling mechanisms, but its involvement to cholesterol-induced NASH pathogenesis remains poorly defined. Herein we have reported a novel effect of α-tocopherol in the transition from hepatic steatosis to NASH. High cholesterol diet alone (without α-tocopherol) in rabbits elevated NASH development as indicated by increased inflammatory response, apoptotic activity and liver fibrosis. Such elevation results from induction of signaling mechanisms since the expressions of IL1β, phospho c-Jun/c-Jun ratio, JNK, caspase 9, CHOP and Bax were increased, and recruitment of macrophage, α-smooth muscle actin (α-SMA) and COL1A1 into the liver tissue were induced. Alpha-tocopherol supplementation inhibited inflammatory response, apoptosis and fibrosis development without affecting lipid accumulation in high cholesterol-induced NASH. Specifically, α-tocopherol lowered the inflammatory level as observed by reduced macrophage infiltration and JNK/c-Jun signaling. Lower inflammatory status co-occurred with the reduction of CHOP and Bax expressions as well as fibrosis-related COL1A1 and α-SMA levels. Taken together, α-tocopherol supplementation inhibits cholesterol-induced NASH development by lowering JNK/c-Jun/inflammation axis in addition to JNK/CHOP/apoptosis signaling, which might contribute to resistance against NAFLD/NASH transition.

Propolis-Based Nanofiber Patches to Repair Corneal Microbial Keratitis

In this research, polyvinyl-alcohol (PVA)/gelatin (GEL)/propolis (Ps) biocompatible nanofiber patches were fabricated via electrospinning technique. The controlled release of Propolis, surface wettability behaviors, antimicrobial activities against the S. aureus and P. aeruginosa, and biocompatibility properties with the mesenchymal stem cells (MSCs) were investigated in detail. By adding 0.5, 1, and 3 wt.% GEL into the 13 wt.% PVA, the morphological and mechanical results suggested that 13 wt.% PVA/0.5 wt.% GEL patch can be an ideal matrix for 3 and 5 wt.% propolis addition. Morphological results revealed that the diameters of the electrospun nanofiber patches were increased with GEL (from 290 nm to 400 nm) and Ps addition and crosslinking process cause the formation of thicker nanofibers. The tensile strength and elongation at break enhancement were also determined for 13 wt.% PVA/0.5 wt.% GEL/3 wt.% Ps patch. Propolis was released quickly in the first hour and arrived at a plateau. Cell culture and contact angle results confirmed that the 3 wt.% addition of propolis reinforced mesenchymal stem cell proliferation and wettability properties of the patches. The antimicrobial activity demonstrated that propolis loaded patches had antibacterial activity against the S. aureus, but for P. aeruginosa, more studies should be performed.

Crossing mesh tails in the Lichtenstein repair method for medial (direct) inguinal hernia: recurrence and chronic pain rates after five years

PURPOSE

This study aimed to determine whether crossing of the mesh's lateral tails is beneficial in Lichtenstein repairs for medial (direct) inguinal hernias.

METHODS

We allocated 116 patients with unilateral medial (direct) inguinal hernias into two groups: mesh tail crossing (group C) or no mesh tail crossing (group N). In group C, the lateral tails were sutured together at the inguinal ligament, whereas the lateral tails were sutured in a parallel position in group N. Visual analog scale (VAS) scores were postoperatively recorded in person at the 1st, 7th, 30th, and 90th days and at the 1st year. The Short-Form Health Survey (SF-36) scores were calculated postoperatively at one month and one year. Examinations to detect hernia recurrence were performed at the end of the 1st year. Follow-ups at the 5th year were performed via phone calls to obtain the Sheffield pain scale and VAS values and to determine the possibility of hernia recurrence.

RESULTS

VAS and SF-36 scores at the 1st, 7th, 30th, and 90th days and 1st year were all higher in group C than in group N. In group C, one patient experienced moderate pain, and one experienced severe pain. In the 5th year, VAS and Sheffield pain scores were significantly higher in group C than in group N.

CONCLUSIONS

During Lichtenstein repair for medial (direct) inguinal hernias, crossing of the mesh tails may increase the frequency of postoperative chronic inguinal pain.

The role of plasma presepsin levels in determining the incidence of septic shock and mortality in patients with sepsis

INTRODUCTION

The present study aimed to investigate the role of plasma presepsin in the early detection of septic shock and in determining the prognosis and mortality of patients with sepsis.

METHODOLOGY

The study was conducted in the emergency department between 1 January 2017 and 1 July 2017. A total of 106 patients 18 years of age or older who were diagnosed with sepsis according to the quick sequential organ failure assessment (qSOFA) criteria were included in this prospective study. The patients' symptoms, vital signs, additional diseases, demographic attributes, laboratory results, Mortality in Emergency Department Sepsis (MEDS) scores, imaging findings and treatments were recorded. Moreover, the patients' blood samples were collected to measure plasma presepsin, procalcitonin and CRP levels.

RESULTS

In total, 55.7% of the patients were female. The median age of the patients was 78 (24-103) years, and their 30-day mortality rate was 67%. The presepsin level was significantly higher in the sepsis group than in the healthy control group (p < 0.001). The presepsin levels did not differ significantly between the sepsis and septic shock groups (p = 0.12). Similarly, the procalcitonin levels did not differ significantly between the sepsis and septic shock groups (p > 0.05). There was no significant difference in the presepsin, procalcitonin and CRP levels between survivor and non-survivor patients (p = 0.74).

CONCLUSIONS

The plasma presepsin level was found to be ineffective in determining the incidence of septic shock and mortality in patients with sepsis in the emergency department.

3D Printed Polycaprolactone/Gelatin/Bacterial Cellulose/Hydroxyapatite Composite Scaffold for Bone Tissue Engineering

Three-dimensional (3D) printing application is a promising method for bone tissue engineering. For enhanced bone tissue regeneration, it is essential to have printable composite materials with appealing properties such as construct porous, mechanical strength, thermal properties, controlled degradation rates, and the presence of bioactive materials. In this study, polycaprolactone (PCL), gelatin (GEL), bacterial cellulose (BC), and different hydroxyapatite (HA) concentrations were used to fabricate a novel PCL/GEL/BC/HA composite scaffold using 3D printing method for bone tissue engineering applications. Pore structure, mechanical, thermal, and chemical analyses were evaluated. 3D scaffolds with an ideal pore size (~300 µm) for use in bone tissue engineering were generated. The addition of both bacterial cellulose (BC) and hydroxyapatite (HA) into PCL/GEL scaffold increased cell proliferation and attachment. PCL/GEL/BC/HA composite scaffolds provide a potential for bone tissue engineering applications.

Comparison of Oxidant and Antioxidant Parameters in Patients with Sjögren’s Syndrome and Healthy Subjects

Objective Oxidative stress may have an effect on the pathogenesis of diseases, including autoimmune rheumatic diseases. We aimed to investigate the serum paraoxonase activity and other oxidant/antioxidant parameters in patients with Sjögren’s syndrome (SS) and healthy controls.

Methods 85 patients with SS and 65 healthy subjects were included in the study. Groups were age and gender-matched and had no liver disease. Serum paraoxonase (PON)-1 activity, stimulated paraoxonase (SPON), PON-1 phenotypes that represent polymorphism (Q192R; QQ, QR, RR), arylesterase (ARE), total oxidant status (TOS), total antioxidant capacity (TAC), oxidative stress index (OSI), advanced oxidative protein products (AOPP), total thioles (TTL) and ischaemia-modified albumin (IMA) were measured in all study participants.

Results Statistically significant differences were found in the QQ and QR+RR phenotype of PON-1 for TAC, TOS and TTL (p<0.001) between SS and healthy groups. The other parameters were statistically insignificant.

Conclusion Antioxidant parameters were lower in SS patients compared with healthy controls. Conversely, oxidant parameters were higher. This imbalance may play a role in SS pathogenesis.

Three-dimensional analysis of acetabular cup orientation and an evaluation of the relationship with pelvic sagittal parameters

BACKGROUND

This study aimed to evaluate the effect of total hip arthroplasty (THA) on sagittal pelvic parameters and to evaluate the effect of sagittal pelvic parameters on acetabular cup orientation.

METHODS

The study included 86 patients who underwent THA for a diagnosis of unilateral coxarthrosis between 2011 and 2015. Measurements were taken of the preoperative and postoperative acetabular cup inclination (ACI), anteversion, and sagittal pelvic parameters. The effect of THA on sagittal pelvic parameters and the effects of the sagittal pelvic parameters on acetabular cup orientation were investigated.

RESULTS

The sagittal pelvic tilt values calculated were mean 9.7° ± 6.3° (2°; 23°) preoperatively and 11.0° ± 6.1° (2°; 25°) postoperatively. The increase in postoperative pelvic incidence (PI) values was determined to be statistically significant (p < 0.05). The preoperative PI values had no significant effect on ACI, but in cases with high preoperative PI values, a tendency to high anteversion values was determined. The mean inclination values were found to be 40.2° ± 11.0° in the low PI group, 41.7° ± 7.4° in the normal PI group, and 44.1° ± 8.3° in the high PI group. As no increase in inclination values was observed with an increase in PI values, no statistical correlation was determined (p = 0.343). Average of anteversion values in the low PI group was 9.2° ± 13.7°, in the normal PI group 19.3° ± 10.5°, and in the high PI group 21.1° ± 12.5°. The difference between the groups was statistically significant (p = 0.001).

CONCLUSION

Evaluating the results of this study, it can be concluded that varying PI values do affect the acetabular cup anterversion in THA. So, preoperative assessment of PI values is important in preventing postoperative acetabular cup malposition.