Oral Cavity Squamous Cell Carcinomas in Patients with a History of Oral Lichen Planus: Frequency and Outcomes

PURPOSE/OBJECTIVE(S)

Oral lichen planus (OLP) is an inflammatory condition which affects the mucous membranes of the oral cavity. While previous studies have described the association between OLP and development of oral cavity cancer, there is currently a paucity of literature examining the impact of this disease on treatment response and prognosis. As such, we present a retrospective cohort study of Oral cavity squamous cell carcinoma (OCSCC) patients with a history of OLP to explore the course of their disease.

MATERIALS/METHODS

Using an IRB approved tertiary care registry of head and neck cancer patients, we identified patients with OCSCC who had a prior diagnosis of OLP. The number of new primary tumors, rates of local (LF), regional (RF) and distant failure (DF), as well as overall survival (OS) were assessed using Cox proportional hazards and Kaplan Meier analysis for actuarial survival estimates.

RESULTS

Fifty-four patients with OCSCC and OLP were identified with 109 individual OCSCC diagnoses. Patients had a median age of 67 years, were predominantly female (n = 42, 77.8%) and never smokers (n = 29, 53.7%) with a median follow up after diagnosis of OCSCC of 46.5 months. Nine patients (16.7%) had a history of immunosuppression of whom 6 (11.1%) had chronic steroid use for treatment of OLP. Within the cohort, 33 (61.1%) of OLP patients had a single OCSCC, 11 (20.4%) had 2, and 10 (18.5%) had >3 separate tumors develop. The most common oral cavity subsites were oral tongue (n = 42, 38.5%), followed by alveolar ridge (n = 14, 12.8%) and gingiva (n = 13, 11.9%). Papillary SCC subtype was identified in 10.1%. 92.7% of tumors (n = 101) were treated with primary surgery, with 23 (21.1%) receiving adjuvant RT and 10 of those patients receiving concurrent chemotherapy. Among resected patients, pathologic stages were predominantly T1-2 (84.1%) and N0 (50% vs N1 15.6% and N2a-3 34.4%). The mean RT dose was 62 Gy in 32 fractions. Locoregional failure occurred in 24.8% of cancers (n = 27), with local and regional failure occurring in 13.8% (n = 15) and 11% (n = 12) of lesions, respectively. Recurrence free survival at 3 and 5 years was 75% and 70.3%, respectively, with overall survival at 3 and 5 years of 71.1% and 67%, respectively.

CONCLUSION

Patients with OCSCC and a history of OLP are predominantly female and never smokers. The tumors that develop in such patients are often early stage but a proportion of patients appear to be at higher risk of developing multiple malignancies and surveillance of this patient population to identify new tumors is crucial.

Definitive Radiotherapy for the Treatment of Gross Disease in Unresected Differentiated Thyroid Cancer

PURPOSE/OBJECTIVE(S)

While surgery (with or without radioactive iodine (RAI)) is the mainstay of locoregional control in differentiated thyroid cancer (DTC), patients with unresectable disease present a clinical challenge. Uncontrolled disease in the neck can lead to substantial morbidity and mortality in DTC and obtaining locoregional control is vital to preserving quality of life and longevity. High dose definitive radiotherapy (RT) for gross disease in DTC is understudied. This study examines the efficacy of definitive RT in this setting.

MATERIALS/METHODS

From an IRB-approved registry of head and neck cancer cases treated at a tertiary care center over a period of 8 years (2014-2022), patients with incompletely resected or unresectable DTC including papillary, follicular, mixed, medullary, and poorly differentiated types were identified. All patients were treated to the neck and/or thyroid regions with visible gross disease to a definitive dose of radiation. The primary endpoint was local control within the radiated portal with a secondary endpoint of locoregional control within the neck.

RESULTS

A total of 31 patients were identified, of whom 74.2% were Caucasian. Fourteen were female (45.2%), and 17 (54.8%) were male. The median age was 68 years (range 26-90) and the median follow-up was 31 months. Histologically, 19 (61.3%) cases were papillary, 4 (12.9%) were follicular, 2 (6.5%) were mixed, 3 (9.7%) were medullary, and 3 (9.7%) were poorly differentiated. Among patients with non-medullary DTC 18 (69.2%) received prior RAI. Twelve patients were treated with radiation at initial diagnosis, while 19 patients were treated at the time of recurrence; two patients received concurrent chemotherapy. Twenty-eight patients (90.3%) were treated with IMRT and 3 (9.7%) were treated with SBRT. The median dose to the gross disease was 66 Gy (range 30-70.4) in 32 fractions (range 5-35). Overall, 5 patients (16.1%) experienced a locoregional failure after RT and all experienced failure in the RT portal. The actuarial infield control/locoregional control of radiation therapy at 3 and 5 years was 84.8% and 74.2%, respectively. Overall survival at 3 and 5 years was 68.5% and 47.4%, respectively. Among patients who had a locoregional failure after RT, 2 patients were salvaged with systemic therapy, 2 patients with surgery, and 1 patient with SBRT re-irradiation (40 Gy/5 fractions). The patient salvaged with SBRT remains without disease 8 months post-RT.

CONCLUSION

Definitive radiotherapy is a highly effective strategy to obtain durable control of unresected DTC. It should be standard for unresected disease and considered as a viable alternative for patients with borderline resectable disease for whom resection would be highly morbid.

Omentin-1 Levels in Hypothyroid Patients with Autoimmune Thyroiditis

OBJECTIVE

To determine Omentin-1 in hypothyroid patients with autoimmune thyroiditis compared to controls.

STUDY DESIGN

Observational study. Place and Duration of the Study: Department of Internal Medicine and Endocrinology, University of Health Sciences, Antalya Training and Research Hospital, Turkiye, between August 2017 and March 2020.

METHODOLOGY

The study included 63 newly diagnosed hypothyroid patients with autoimmune thyroiditis and 40 healthy volunteers. Body mass index, fasting blood glucose, homeostasis model assessment for insulin resistance, lipid profile, thyroid function tests, thyroid autoantibodies, and omentin-1 levels were determined before and after treatment with levothyroxine sodium in all participants.

RESULTS

Omentin-1 was significantly higher in the control subjects [15.05 (12.12-18.06) ng/ml] than in the hypothyroid patients with autoimmune thyroiditis [3.04 (2.39-3.76) ng/ml, p<0.001]. There was no significant difference in omentin-1 level in patients who achieved euthyroidism by treatment (p=0.26). In correlation analysis, serum omentin-1 level was found to correlate negatively with thyroid-stimulating hormone (r=-0.27, p=0.006), anti-thyroid peroxidase (r=-0.32, p=0.001), and anti-thyroglobulin antibodies (r=-0.26, p=0.007), whereas it correlated positively with free triiodothyronine (r=0.22, p=0.021) and free thyroxine (r=0.24, p=0.012).

CONCLUSION

Lower omentin-1 levels in hypothyroid patients with autoimmune thyroiditis and its negative correlation with thyroid-stimulating hormone suggest that omentin-1 may play some role in hypothyroidism and autoimmune thyroiditis.

KEY WORDS

Hypothyroidism, Chronic autoimmune thyroiditis, Omentin-1.

WEIGHT LOSS AND BEYOND, ASSESSMENT OF QUALITY OF LIFE AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY USING BAROS IN PATIENTS WITH OBESITY IN TURKEY

Context

Sleeve gastrectomy is an effective method for management of obesity. The Bariatric Analysis and Reporting Outcome System (BAROS) is a comprehensive and standard system for the assessment of outcomes of weight loss surgery. It is consisted of weight loss, changes in obesity-related comorbidities and quality of life measurements. We investigated results of the sleeve gastrectomy based on the BAROS.

Material and Methods

Outcomes of laparoscopic sleeve gastrectomy surgery was studied in 45 patients with obesity (11 male, 34 female), after 45 months in Turkey.

Results

Total weight loss was 26.4±0.1% of body weight at 45 months. Weight regain was seen in 97.8% of the patients with an average 14.5 kg and 13.7% body mass index points. The surgery caused 76% decrease in incidence of obstructive sleep apnea, 73% decrease in type 2 diabetes, 63% decrease in hyperlipidemia and 62% decrease in hypertension. Significant improvement is observed in all quality-of-life parameters. The final score of the BAROS was 4.23±1.02.

Conclusion

Based on BAROS, sleeve gastrectomy provides significant improvements in weight loss, incidence of medical comorbidities and quality of life after surgery. Future studies should address prevention of weight regain after the surgery.

Predictive value of the frontal QRS-T angle for a permanent pacemaker requirement in patients undergoing transcatheter aortic valve implantation

OBJECTIVE

Despite recent advances, the requirement for permanent pacemaker (PPM) implantation after transcatheter aortic valve implantation (TAVI) remains high. The frontal QRS-T angle (fQRS-Ta) indicates ventricular electrical instability as well as ventricular depolarization and repolarization heterogeneity. The predictive value of fQRS-Ta for the PPM requirement after TAVI is lacking. Therefore, we aimed to investigate the predictive value of baseline fQRS-Ta for the requirement of PPM after TAVI.

PATIENTS AND METHODS

This is a retrospective study conducted at a single tertiary care center. The patients were divided into two groups: those who required a pacemaker (PPM group) and those who did not (No-PPM group). The optimal fQRS-Ta cut-off value for predicting a PPM requirement was determined by using receiver operating characteristic (ROC) curve analysis. Univariate and multivariate Cox regression analyses were used to determine the independent predictors of post-TAVI PPM placement.

RESULTS

Final study population consisted of 184 patients. The mean age of the patients was 79.41 ± 7.88 years, and 61% (n = 113) were women. Twenty-seven patients who required PPM after TAVI were considered as the 'PPM group'. The baseline frontal QRS and T axes did not differ between the groups, but the fQRS-Ta was significantly higher in the PPM group. ROC analysis performed for the prediction of post-TAVI PPM need, the fQRS-Ta cut-off value was found to be 100.5 with a sensitivity of 74.1% and a specificity of 60.5% [AUC (95% CI): 0.637 (0.520 - 0.755), p: 0.023]. In multivariate analysis, age [HR (95% CI): 1.071 (1.005 - 1.142), p: 0.034] and fQRS-Ta [HR (95% CI): 2.509 (1.084 - 6.399), p: 0.044] were identified as independent risk factors for PPM requirement after TAVI.

CONCLUSIONS

This study demonstrated that age and baseline fQRS-Ta were independent predictors of PPM requirements after TAVI in patients with aortic stenosis.

The effect of L-thyroxine treatment on ventricular dysfunction and pulmonary arterial stiffness in patients with subclinical hypothyroidism

OBJECTIVE

In our study, we aimed at evaluating the change in biventricular functions and pulmonary arterial stiffness (PAS) in patients with subclinical hypothyroidism (SH) in whom euthyroidism was achieved with L-thyroxine therapy.

PATIENTS AND METHODS

70 SH patients and 75 healthy volunteers were included in our study consecutively. Baseline demographic and echocardiographic data of the participants were recorded. The data obtained in the control evaluation 6 months after the euthyroidism were achieved in the SH group patients started on L-thyroxine treatment and then compared with the baseline measurements.

RESULTS

The mean age of patients in the SH group was 44.1 ± 9.4 years and 47.1% were women. Euthyroidism in SH patients was achieved with a mean daily L-thyroxine treatment of 59 µg/day for a mean of 16.1 ± 4.5 weeks. Positive changes in metabolic and hormonal profiles were achieved after L-thyroxine treatment in SH patients. It was determined that left ventricular and right ventricular isovolumetric relaxation and myocardial performance index were higher in SH patients compared to the control group, and these measurements were observed to decrease significantly with L-thyroxine treatment (p < 0.05 for each). While PAS was 16.9 ± 3.1 kHz/ms in the control group, it was 25.2 ± 5.3 kHz/ms in the SH group (p < 0.05). After L-thyroxine treatment, PAS measurements decreased to 17.2 ± 3.2 kHz/ms (p < 0.05) in the SH group and showed a positive change. Thyroid-stimulating hormone (TSH) change (Δ TSH) with Δ E/A ratio (r: -0.407, p < 0.001), right ventricular myocardial performance index (Δ RV MPI) change (r: 0.404, p < 0.001) and PAS change (Δ PAS) (r: 0.458, p < 0.001) found to be correlated.

CONCLUSIONS

SH is associated with dysfunction in the biventricular and pulmonary vascular bed. Biventricular functions and PAS change positively in SH patients with L-thyroxine treatment.

P11.03.B BXQ-350: Modulating ceramide and Sphingosine-1-Phosphate for anti-tumor activity and potential mitigation of chemotherapy induced peripheral neuropathy

Background

Sphingolipids are a class of bioactive signaling molecules implicated in multiple cellular processes and molecular pathways. Many publications have indicated that among these sphingolipids, sphingosine-1-phosphate (S1P) is a key sphingolipid that promotes cancer cell survival and proliferation, activates multiple oncogenic pathways, and stimulates immuno-suppressor cell populations promoting a pro-tumoral microenvironment. Many of these publications have also implicated S1P with chemotherapy induced peripheral neuropathy, a debilitating and serious side effect that may impact therapeutic treatments and patient’s quality of life.

Material and Methods

BXQ-350 is a nanovesicle of Saposin C, an allosteric activator of sphingolipid metabolism, that has broad anticancer activity, potentially in part by lowering systemic S1P levels. BXQ-350 was investigated in a Phase 1 dose-escalation safety study in an all-comer cancer patients with advanced solid malignancies, including CNS tumors (NCT02859857) to determine its safety profile and its potential clinical activity as a single agent in cancer patients. Samples were collected to determine pharmacokinetics and explore potential biomarkers.

Results

11 patients (~15% of evaluable patients) with advanced disease had a clinical benefit and amongst these, 8 patients (~11% of evaluable patients) had PFS&gt; 6 months with 2 patients still on study five years after enrollment. Analysis of patient’s samples revealed that BXQ-350 decreases systemic S1P levels in the majority of the patients experiencing a clinical benefit. In addition, several patients with established CIPN spontaneously reported improvements of their symptoms shortly after BXQ-350 administration. Analysis of these patients’ samples also revealed that S1P systemic levels had decreased, as well as pro-inflammatory cytokines associated with CIPN.

Conclusion

While these results are exploratory and preliminary in nature, they suggest that BXQ-350’s mechanism of action may represent a novel anti-cancer approach that may also mitigate CIPN.

The predictive value of residual SYNTAX score and SYNTAX revascularization index for contrast-induced nephropathy in patients with ST-segment elevation myocardial infarction

OBJECTIVE

We aimed to evaluate the association of incomplete revascularization score and the treated coronary artery disease burden with the development of contrast-induced nephropathy (CIN) in patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous intervention. Incomplete revascularization score was expressed by the residual SYNTAX (SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery) (rSS) and the treated coronary artery disease burden was expressed by the SYNTAX revascularization index (SRI).

PATIENTS AND METHODS

In our study, 604 sequential patients who underwent percutaneous coronary intervention diagnosed with STEMI between January 2018 and December 2021 were included. Patients were categorized into two groups; 'CIN (+)' who developed CIN and 'CIN (-)' who did not develop CIN. Baseline demographic, laboratory, echocardiographic, and angiographic data of the groups were compared. SYNTAX score I and II, rSS, and SRI were calculated. The diagnostic power of these angiographic parameters in the prediction of CIN was evaluated. Predictors for the development of CIN in STEMI patients were investigated.

RESULTS

The mean age of the patients included in our study was 58.7 ± 12.4 years, and 79.9% of them were men. CIN was observed in 17.8% of study patients. The SYNTAX score [17.8 (11.4-24.2) vs. 15.1 (10.1-21.2); p = 0.008] and rSS [8.14 (3.9-116) vs. 4.2 (2.6-8.2); p < 0.001] were higher and SRI [56.2 ± 10.2 vs. 71.1 ± 13.6; p < 0.001] was lower in the CIN (+) group compared to the CIN (-) group. In predicting CIN, rSS was found to have significant diagnostic power at a cut-off value of 5.2, sensitivity of 81% and specificity of 69% [AUC (95% CI) = 0.752 (0.602-0.814); p < 0.001]. In logistic regression analysis, rSS [OR (95% CI) = 1.492 (1.124-1.884); p < 0.001] and SRI [OR (95% CI) = 1.055 (1.027-1.092); p < 0.001] were defined as independent predictors for the development of CIN.

CONCLUSIONS

rSS and SRI are associated with CIN in STEMI patients. Although rSS is superior in predicting CIN, both angiographic scorings have significant diagnostic power. rSS and SRI are independent predictors for the development of CIN.

Are the nerves supplying the anterior sacroiliac joint nociceptive?

BACKGROUND

Sacroiliac joint (SIJ) pain is often difficult to diagnose. Moreover, while its anatomical characteristics have been well studied, its innervation and the contributions of particular nerves remain controversial, especially in relation to posterior joint innervation. To our knowledge, previous studies have not investigated the presence of nociceptive fibres in the nerves innervating the anterior SIJ.

MATERIALS AND METHODS

Eight adult cadaveric sides underwent dissection of the anterior SIJ. Adjacent anterior rami were examined for branches to the anterior SIJ. Any branches contributing to the anterior SIJ were measured and then resected. These samples were fixed in formalin and substance P was identified immunohistologically.

RESULTS

On all sides, 1-2 small branches (mean diameter of 0.33 mm) arose from the posterior aspect of the L4 anterior ramus (12.5%), the L5 anterior ramus (62.5%), or simultaneously from both the L4 and L5 anterior rami (25%). These branches had a mean length of 13.5 mm. All histological samples contained nerve tissue. All samples of nerve fibres traveling to the anterior SIJ were positive for diffuse substance P reactivity. There were no histological differences between sides or sex. Each of the branches identified as travelling to the SIJ exhibited similar positivity for substance P.

CONCLUSIONS

This cadaveric study demonstrates that the anterior SIJ nerve fibres carry pain fibres. This new knowledge has application to patients with SIJ syndrome and to its various treatments including interventional approaches to SIJ pain.

GMFCS level improvement in children with cerebral palsy treated with repeat botulinum toxin injections and intensive rehabilitation: A retrospective study

PURPOSE

The Gross Motor Functional Classification System (GMFCS) provides a standardized classification of motor disability in children with cerebral palsy (CP) that is typically considered longitudinally stable. Here, changes in GMFCS levels of children with CP who received repeated botulinum toxin A (BoNT-A) injections within an intensive rehabilitation approach were evaluated.

METHODS

This retrospective, observational study included 503 children with CP (GMFCS I-V) treated in a single university rehabilitation clinic. Individualized treatment plans and a variety of rehabilitation techniques were incorporated within an integrated model of care. Each child received≥2 repeated BoNT-A injections as well as an intensive rehabilitation program.

RESULTS

GMFCS level following repeat treatment improved in 42.1% of the patients and worsened in 3 patients; 14.9% of children showed improvement after 1 treatment cycle, 12.3% after 2 cycles, 7.6% after 3 cycles, 3.6% after 4 cycles, and 3.8% after≥5 cycles. Type of involvement (p < 0.001), baseline GMFCS (p = 0.001), number of treatment cycles (p < 0.001) and presence of severe dystonia (p = 0.032) were significant predictors of GMFCS improvement, but age and gender were not.

CONCLUSION

Children with CP may change GMFCS level when intensive rehabilitation programs are combined with repeated BoNT-A injections.

An online functional assessment experience in individuals over 65+ during Covid 19 pandemics: physiotherapist opinion & participant opinion

Funding Acknowledgements

Type of funding sources: None.

Background

The quarantine during COVID-19 pandemic affects the clinical visits of elderly people. Since, telehealth gained importance, it is essential to adapt routine visits to the tele-assessment for elderly people especially in high risk factor for both functional impairment and fall risks. Our aim was to present our online assessment experiences in the elderly who underwent particular home quarantine during COVID-19 pandemics. Method: Thirty-three participants aged 65-85 (mean = 71.33 ± 5.35/years, 20 women, 13 men) those never attended an online assessment before were invited to a video-conference based assessment session. It was advised that a relative of the participant or caregiver must attend the online assessment session and follow the instructions of the physiotherapist. The assessments were conducted in the following sequence over seven main topics that are important in terms of functionality in the elderly: (1) physical activity were questioned using International Physical Activity Questionnaire-Short Form, (2) the functional performance were tested with 30 seconds Sit-to-Stand test (SST), (3) participation to the daily living activities with KATZ Index, (4) coronavirus anxiety with Coronavirus Anxiety Scale (CAS), (5) fear of falling with Falls Efficacy Scale, (6) the balance and mobility with Timed-Up and Go test (TUG) in a 3-meter corridor, and (7) frailty with Clinical Frailty Scale. The assessments were done by six physiotherapists (one PhD, 2 MSc, and 3 BSc). The opinions of the participants and physiotherapists regarding their experiences were noted. Result: All participants were finished the assessment and not reported adverse events. The mean of all outcomes showed in Table 1. The mean assessment time was 23.26 ±6.89 minutes. The bad internet connection reported in only one session. Seven of the participants (21.2%) mentioned that SST or TUG were somewhat effortful despite their short duration. The physiotherapists also reported that ensuring an appropriate testing environment for the sit to stand test and Timed-Up and Go test were not always possible. In addition, the sit-to stand test Two of the participants (6 %) were felt discomfort from the questions of CAS. Twenty-one (63.6 %) online assessment were rated as "good" while 12 (36.4 %) were rated as "fair" by the relative of the participant or caregiver in terms of preparing the tools (chair etc.) and testing environment. No problem reported by both therapists and participants related to the questions of IPAQ-SF, CFS, KATZ or FES. Conclusion: This study indicated that an online tele-assessment session is safe and applicable in elderly who underwent home quarantine during COVID-19 pandemic. It was observed that an application of survey based assessments were easier than functional assessments. The results of this study offer an exemplary tele-assessment session for elderly people. Future studies may focus the consistency of the tele-assessment and clinic based assessment results.

The frailty and falling in related with functional performance, balance and physical activity in elderly during Covid-19 pandemics

Funding Acknowledgements

Type of funding sources: None.

Background

Falls and frailty are main causes of morbidity and frequenty associated with functional performance, balance and physical activity. The restrictions imposed by the COVID-19 pandemic force the elderly to spend most of their time at home which may cause further functional problems. Therefore, identifying the risk factors during the pandemic can help to prevent the elderly from frailty and falls. Aim: Our aims are to investigate the clinical frailty profile and falls in relation to functional performance, balance, fear of falling and physical activity and to compare these parameters of the elderly with and without falling history during the COVID-19 pandemics. Method: Thirty-three participants aged 65-85 (mean = 71.33 ± 5.35/years, 20 women, 13 men) who have never had COVID-19 were included in the study. The participants were invited to an online video-conference based assessment. The number of falls during the last year were asked. Clinical frailty severity was assessed with Clinical Frailty Scale. The fear of falling were assessed using Falls Efficacy Scale (FES). The functional performance of the participants were tested with 30 seconds Sit-to-Stand test. The balance and mobility was evaluated with Timed-Up and Go test in a 3 meter corridor. The physical activity level of the participants were questioned using International Physical Activity Questionnaire-Short Form (IPAQ-SF) and vigorous level of physical activity (VPA), moderate level of physical activity (MPA) and walking were also calculated. Results: The mean scores of the outcomes among participants were shown in Table 1. Clinical frailty was significantly higher in women compared to men (p = 0.08). Clinical frailty score, fear of falling and sit to stand performance were significantly worse in fallers. There were negative weak to moderate correlations between frailty and sit to stand performance (p = 0.001) and MPA (p = 0,016). The clinical frailty was also positively correlated with FES (p &lt; 0.001). FES showed positive correlation with Time-Up and Go performance (p = 0.001) and negative correlation with sit to stand performance (p &lt; 0.001) and MPA (p = 0,036). Conclusion: Our results demonstrated that; clinical frailty, fear of falling and sit to stand performance were associated with the fall history in elderly. In addition, clinical frailty score were higher in women. Our results indicate that, people who have fall history may tend to be frailer and may have lower functional performance, balance and physical activity. The encouragement of the elderly to increased physical activity and exercise program may decrease the frailty score and falling risk especially in elderly women during COVID-19 pandemics.

Is Prevention of Hemolysis Possible in Blood Samples Collected from IV catheters in the Emergency Department?

BACKGROUND

The effectiveness of aspiration and vacuum filling method with an adaptor in reducing hemolysis was investigated.

METHODS

The study was conducted in the yellow zone of the Emergency department. Two different apparatuses that draw blood with two different techniques from an IV catheter were compared with our routine procedure. The first system drew blood with aspiration technique into 4.9 mL serum gel tube (Sarstedt S-Monovette®). The second was vacuum filling with a specific adaptor attached to the same catheter drawing the blood into vacuumed serum separator tubes (BD Vacutainer® SST™II and Luer-Lok™ Access Device (LLAD). In our routine, we use plastic syringes and deliver it into the same serum separator vacuum tubes. We measured the hemolysis index, AST, CK, potassium, and LDH.

RESULTS

Hemolysis rates of aspiration method vs. routine were 0.80% and 38.7% (p < 0.001) and of vacuum filling with adaptor vs. routine were 13.5% and 40.6%, respectively (p = 0.0001). The hemolysis rate of the aspiration method was lower than the vacuum filling adaptor method (p = 0.0004). Both techniques showed better performance when measured parameters were compared; aspiration technique being the superior (all p < 0.0001).

CONCLUSIONS

Aspiration method was more successful then vacuum filling methods in reducing hemolysis.

The positive psychology constructs of parents of children with intellectual and developmental disabilities in Turkey

BACKGROUND

The purpose of this exploratory study was to examine positive psychology constructs (life orientation/optimism, life satisfaction, happiness, psychological well-being and personal well-being) that may predict the family quality of life (FQOL) of parents of children with intellectual and developmental disabilities (IDD) in Turkey.

METHODS

Data were obtained from a convenience sample of 660 parents of children with IDD who responded to six assessments, including a measure of FQOL. An analysis using stepwise multiple regression was conducted to identify predictors of FQOL as rated by parents.

RESULTS

The four constructs including personal well-being, psychological well-being, life orientation (optimism) and life satisfaction significantly explained 60% of the total variance of FQOL. The amount of explained variance, beta scores and correlations suggests that these positive psychology constructs are significant predictors of FQOL of parents of children with IDD in Turkey.

CONCLUSION

The study findings suggested that positive psychological constructs at the individual level were positively related to FQOL at the group level. Personal well-being was the strongest predictor of FOQL of parents who have children with IDD in Turkey. The results also indicated that other constructs including psychological well-being, an optimistic life orientation and life satisfaction contribute significantly to the FQOL of parents of children with IDD.

Temporal Trends in the Epidemiology of HIV in Turkey

OBJECTIVE

The aim of this study was to analyze the temporal trends of HIV epidemiology in Turkey from 2011 to 2016.

METHODS

Thirty-four teams from 28 centers at 17 different cities participated in this retrospective study. Participating centers were asked to complete a structured form containing questions about epidemiologic, demographic and clinical characteristics of patients presented with new HIV diagnosis between 2011 and 2016. Demographic data from all centers (complete or partial) were included in the analyses. For the cascade of care analysis, 15 centers that provided full data from 2011 to 2016 were included. Overall and annual distributions of the data were calculated as percentages and the Chi square test was used to determine temporal changes.

RESULTS

A total of 2,953 patients between 2011 and 2016 were included. Overall male to female ratio was 5:1 with a significant increase in the number of male cases from 2011 to 2016 (p<0.001). The highest prevalence was among those aged 25-34 years followed by the 35-44 age bracket. The most common reason for HIV testing was illness (35%). While the frequency of sex among men who have sex with men increased from 16% to 30.6% (p<0.001) over the study period, heterosexual intercourse (53%) was found to be the most common transmission route. Overall, 29% of the cases presented with a CD4 count of >500 cells/mm3 while 46.7% presented with a CD4 T cell count of <350 cells/mm3. Among newly diagnosed cases, 79% were retained in care, and all such cases initiated ART with 73% achieving viral suppression after six months of antiretroviral therapy.

CONCLUSION

The epidemiologic profile of HIV infected individuals is changing rapidly in Turkey with an increasing trend in the number of newly diagnosed people disclosing themselves as MSM. New diagnoses were mostly at a young age. The late diagnosis was found to be a challenging issue. Despite the unavailability of data for the first 90, Turkey is close to the last two steps of 90-90-90 targets.

AB0437 OESOPHAGEAL DILATATION ON HIGH-RESOLUTION CT CHEST IN SYSTEMIC SCLEROSIS: SIGNIFICANT INDEX?

Background:

Systemic sclerosis (SSc) is chronic, autoimmun multisystem disorder presented by thickening and fibrosis of the skin and internal organs. Esophageal involvement is one of the most common manifestation. Esophageal enlargement on HRCT is a common finding in scleroderma patients and may also be associated with other scleroderma-related clinical findings (1).

Objectives:

The aim of this study to evaluate the association between esophageal dilatation on chest HRCT at diagnosis with the other SSc features.

Methods:

The study was planned for SSc patients registered between October 2007 and September 2020 in Dokuz Eylul University Rheumatology Department database. Demographics, clinical features and medical history were recorded. The baseline HRCT reports were screened in terms of esophageal dilatation. Then, the initial HRCT images were assessed for esophageal dilatation by an experienced chest radiologist according to recommendation of Pitrez et al.

Results:

In our study, there were 233 SSc patients (f:206 M:27, mean age 59.9±12.7 years) 71 (31.4%) of them diagnosed with diffuse disease. Median follow-up of study was 73 (1-272) months. Esophageal dilatation on HRCT was detected in 60 (25.8%) of SSc patients. 67 out of 155 patients (43.2%) had proof of esophageal involvement in esophageal transit scintigraphy. There is no statistical correlation was found between esophageal dilatation on HRCT with gender, smoking, arthritis, pulmonary hypertension and autoantibody subtypes. Development of digital ulcer and telangiectasia is statistically higher in SSc patients with oesophageal dilatation on baseline chest HRCT (p=0.001 and p=0.039, respectively). There was a positive correlation between Modified Rodnan Skin Score (mRss) and esophageal dilatation (r=0.213, p: 0.004).

Conclusion:

HRCT can be a reproducible and non-invasive method for evaluating esophageal dilatation. Presence of esophageal dilatation at baseline HRCT might be indicative for pulmonary involvement and SSc related gastrointestinal complications. Consecutive chest HCRT should be evaluated to obtain more reliable data about the relationship between esophageal dilatation and SSc related clinical features.

References:

[1]Pitrez EH, Bredemeier M, Xavier RM et al.Ooesophageal dysmotility in systemic sclerosis:comparison of HRCT and scintigraphy. Br J Radiol 2006; 79: 719–24.

Table 1.

Clinical and demographic characteristics of the presence of esophageal dilatation on HRCT

Esophageal dilatation on HRCTTotal (n=233)Yes (n=60, 25.8%)No (n=173, 74.2%)pMean±SD.Mean±SD.Mean±SD.Age, years59.9±12.759.7±12.260.1 ±12.6>0.05n%n%n%Female20688,4%5388,3%14986,1%>0.05Smoking7933,9%1931,7%6034,7%>0.05Diffuse SSc7130,5%2338,3%4425,4%>0.05Overlap syndrome3314,2%813,3%2514,5%>0.05Pulmonary fibrosis11850,6%4270,0%7643,9%>0.05Arthritis8034,3%2338,3%5632,4%>0.05Telengiectasia15667,0%4880,0%10560,7%0,039Digital ulcer8737,3%3456,7%5129,5%0,001Anti-Scl 70 (+)8938,2%2846,7%5934,1%>0.05Anti-centromer (+)7532,2%1525,0%5934,1%>0.05

Disclosure of Interests:

None declared

Navigated iliac screw placement may reduce radiation and OR time in lumbopelvic fixation of unstable complex sacral fractures

Purpose

Instability of the posterior pelvic ring may be stabilized by lumbopelvic fixation. The optimal osseous corridor for iliac screw placement from the posterior superior iliac spine to the anterior inferior iliac spine requires multiple ap- and lateral-views with additional obturator-outlet and -inlet views.

The purpose of this study was to determine if navigated iliac screw placement for lumbopelvic fixation influences surgical time, fluoroscopy time, radiation exposure, and complication rates.

Methods

Bilateral lumbopelvic fixation was performed in 63 patients. Implants were inserted as previously described by Schildhauer. A passive optoelectronic navigation system with surface matching on L4 was utilized for navigated iliac screw placement. To compare groups, demographics were assessed. Operative time, fluoroscopic time, and radiation were delineated.

Results

Conventional fluoroscopic imaging for lumbopelvic fixation was performed in 32 patients and 31 patients underwent the procedure with navigated iliac screw placement. No differences were found between the groups regarding demographics, comorbidities, or additional surgical procedures.

Utilization of navigation led to fluoroscopy time reduction of more than 50% (3.2 vs. 8.6 min.; p < 0.001) resulting in reduced radiation (2004.5 vs. 5130.8 Gy*cm²; p < 0.001). Operative time was reduced in the navigation group (176.7 vs. 227.4 min; p = 0.002) despite the necessity of additional surface referencing.

Conclusion

For iliac screws, identifying the correct entry point and angle of implantation requires detailed anatomic knowledge and multiple radiographic views. In our study, additional navigation reduced operative time and fluoroscopy time resulting in a significant reduction of radiation exposure for patients and OR personnel.

Comparing the effects of conventional and microwave roasting methods for bioactive composition and the sensory quality of cold-pressed orange seed oil

This study aims to report the composition of bioactives and volatile aromatic compounds, and determine the descriptive sensory properties of cold-pressed orange seed oil. The effects of oven pre-roasting and microwave pre-roasting of the seeds before cold pressing were compared. Thirteen sensory parameters were used to define the oil samples. The major bioactive components of the orange seed oils were naringin, hesperidin, and trans-ferulic acid. Flavonoids constituted the main phenolic class with 78.5% and 74.4%, followed by phenolic acids with 21.4% and 25.5% in the oven and microwave pre-roasted oil samples. The mean concentration of hesperidin and naringin varied from 903.4 to 909.6 mg/kg and from 234.3 to 299.8 mg/kg, respectively. The results showed for the first time in the literature that orange seed oil contains some volatile aromatic compounds and glycosylated flavanones that could have functional properties. Hence, cold-pressed orange seed oil could be suggested as the new potential health-promoting oil.

Volar percutaneous screw fixation for scaphoid nonunion

Background

Percutaneous screw fixation is widely used in acute fractures of the scaphoid. In this study, we aimed to present our results with volar percutaneous screw fixation in patients with scaphoid nonunions.

Methodology

A total of 12 patients with scaphoid nonunion (≥13 weeks) that underwent volar percutaneous screw fixation were evaluated retrospectively. Two of the patients were female, and 10 were male. Mean age was 27 years (range = 19-41). The mean time that elapsed between the fracture and surgical procedure was 7.5 months (range = 4-12). According to the anatomic location, 33.3% were proximal pole, and 67.7% were waist fractures. All of the patients underwent percutaneous fixation with a headless cannulated screw from volar part under fluoroscopic guidance. Clinical evaluation was performed according to the modified mayo wrist scoring system (MMWS). The absence of a radiolucent fracture line on the radiographs was considered "union" on radiological evaluation.

Results

The mean follow-up time was 18 weeks (range = 8-36). Union was achieved in all patients (91.6%), except one. The mean time to union was 15.5 weeks (range = 8-30). Based on MMWS system, 8 patients were interpreted as excellent, 3 patients as good.

Conclusion

Percutaneous fixation in appropriate patients provides satisfactory results with high union and minimal complication rates in scaphoid nonunions.

Cisplatin plus Vinorelbine as a Salvage Regimen in Refractory Breast Cancer

Aims and background

Breast cancer refractory to known effective agents is one of the major clinical problems frequently encountered in practice. Cisplatin and vinorelbine are known to be active drugs in anthracycline-refractory cases. In this phase II study, the effectiveness and tolerability of cisplatin and vinorelbine was investigated when used in combination as a salvage regimen in the treatment of metastatic refractory breast cancer.

Study design

Twenty-four patients with advanced refractory breast cancer who had been previously treated with a regimen containing doxorubicin were included in the study. Six of the 24 patients also received taxanes after failure of doxorubicin. Cisplatin at 80 mg/m2 on day 1 and vinorelbine at 25 mg/m2 on days 1 and 8 were given every 3 weeks.

Results

A total of 98 cycles of chemotherapy was given, with a median of 4/patient. The response rate was 25% (2 [8.3%] complete and 4 [16.7%] partial responses). The median survival rates were 14 months in responders and 5.5 months in nonresponders (P = 0.0282). One complete and one partial response were observed in patients previously treated with paclitaxel (overall response rate, 33%). The median response duration was 12.5 mo (range, 4–21) in complete and 4.5 mo (range, 1.5–13) in the partial response group. Grade 3 and 4 neutropenia occurred in 9 patients, with no toxic deaths. Grade 2-3 nausea and vomiting in 6 patients and grade 1 neuropathy in 1 patient were noted.

Conclusions

Although the number of cases is insufficient to indicate that the combination will be effective, it is noteworthy in consideration of anthracycline and taxane refractory cases. A combination of cisplatin and vinorelbine seems to be a reasonable and acceptable choice as an alternative salvage regimen in such cases.

Ultrasonographic findings in the epididymis of pediatric patients with testicular torsion

INTRODUCTION

Although grayscale ultrasound and color Doppler ultrasound characteristics of the torsed testis are well established in the literature, less is known about its anatomic partner: the epididymis.

OBJECTIVE

The purpose of this study was to describe the ultrasound characteristics of the epididymis in pediatric patients with testicular torsion, and to describe their potential role as prognostic criteria for testicular salvage outcomes.

STUDY DESIGN

During a retrospective review of 217 pediatric patients with acute testicular torsion during 2009-2016, morphological features of the epididymis from scrotal ultrasounds (size, parenchymal characteristics, and vascular flow of both epididymis heads), as well as patient demographics, time duration, surgical outcomes, histopathology results, and follow-up periods were analyzed.

RESULTS

Mean epididymis size and twisting degree were significantly higher in the torsed testes than in the contralateral epididymis (P < 0.001) (Summary table). Cystic structures in the epididymis were identified: a higher number of cysts was associated with testicular non-viability (P = 0.025) and higher twisting degree (P = 0.017). Histopathologic examination showed that these spaces were infiltrated connective tissue most likely formed by venous congestion and vessel rupture.

DISCUSSION

Scrotal ultrasound can provide information on testicular morphology and viability, as well as morphological changes in the epididymis over time in pediatric patients with testicular torsion. These findings may provide potential prognostic information regarding testicular viability, as a higher number of cystic spaces in the epididymis was associated with a higher rate of testicular non-viability and a higher twisting degree. In addition, the epididymis size (volume) can change during the time course of the ischemic state.

CONCLUSIONS

This was the first study to describe and analyze epididymis ultrasound findings in pediatric patients with testicular torsion and to correlate them with testicular salvage outcomes. Further prospective studies are needed to determine the role of epididymis ultrasound findings as a potential pre-operative prognostic tool.

Computer-aided diagnosis of periapical cyst and keratocystic odontogenic tumor on cone beam computed tomography

BACKGROUND AND OBJECTIVES

In this article, we propose a decision support system for effective classification of dental periapical cyst and keratocystic odontogenic tumor (KCOT) lesions obtained via cone beam computed tomography (CBCT). CBCT has been effectively used in recent years for diagnosing dental pathologies and determining their boundaries and content. Unlike other imaging techniques, CBCT provides detailed and distinctive information about the pathologies by enabling a three-dimensional (3D) image of the region to be displayed.

METHODS

We employed 50 CBCT 3D image dataset files as the full dataset of our study. These datasets were identified by experts as periapical cyst and KCOT lesions according to the clinical, radiographic and histopathologic features. Segmentation operations were performed on the CBCT images using viewer software that we developed. Using the tools of this software, we marked the lesional volume of interest and calculated and applied the order statistics and 3D gray-level co-occurrence matrix for each CBCT dataset. A feature vector of the lesional region, including 636 different feature items, was created from those statistics. Six classifiers were used for the classification experiments.

RESULTS

The Support Vector Machine (SVM) classifier achieved the best classification performance with 100% accuracy, and 100% F-score (F1) scores as a result of the experiments in which a ten-fold cross validation method was used with a forward feature selection algorithm. SVM achieved the best classification performance with 96.00% accuracy, and 96.00% F1 scores in the experiments in which a split sample validation method was used with a forward feature selection algorithm. SVM additionally achieved the best performance of 94.00% accuracy, and 93.88% F1 in which a leave-one-out (LOOCV) method was used with a forward feature selection algorithm.

CONCLUSIONS

Based on the results, we determined that periapical cyst and KCOT lesions can be classified with a high accuracy with the models that we built using the new dataset selected for this study. The studies mentioned in this article, along with the selected 3D dataset, 3D statistics calculated from the dataset, and performance results of the different classifiers, comprise an important contribution to the field of computer-aided diagnosis of dental apical lesions.

Investigation of RadFET response to X-ray and electron beams

The irradiation response of Radiation Sensing Field Effect Transistor (RadFET), also known as MOSFET/pMOS dosimeter, to high energy X-rays and electron beams was investigated. The threshold voltages before and after irradiation were measured and the trap densities in the gate oxide and oxide/silicon interface of the RadFETs are evaluated. The RadFETs were irradiated with 6MV X-rays, and 10 and 18MeV electron beams emitted from a Linear accelerator (LINAC). Linear and non-linear fits to experimental results showed that after an initial linear response up to several Gy, deviation from the linearity occurred due to electric field screening by the radiation induced oxide trapped charges. The radiation-induced fixed traps (FTs) and switching traps (STs) were analysed and the FT density was found to be higher than the ST density for all beam types and doses. The radiation response, fading characteristics, and variation of the trapped charges of the RadFETs showed similar behaviour in tests.

Effects of microwave roasting on the yield and composition of cold pressed orange seed oils

The aim of this study was to valorize orange (Citrus sinensis) seeds, which are generated as waste. This study presents data about raw orange seed, the meal gained after cold pressing, and characterization data of the cold pressed seed oils. Furthermore, the effects of microwave roasting of the seds compared to regular roasting (control) were determined. The oil yield of orange seed cold pressing was around 52.93–62.99%. After cold pressing, 13.57–17.97% oil remained in the meal together with 20.68–25.61% protein. Hence, pressed meals could be valorized for different purposes. Except for turbidity, the color b* value, free acidity, the p-anisidine value and antioxidant capacity, there was no significant difference between the two oil samples for the measured physicochemical properties. Six different fatty acids were quantified and the major fatty acids were linoleic, palmitic and oleic acids. The fatty acid composition of the orange seed oil can be accepted as nutritionally balanced. Among the fifteen sterols quantified, ß-sitosterol was dominant (around 77–78%). Likewise, the α-tocopherol content of the samples was not significantly different. The thermal onset and peak temperatures, and enthalpies for crystallization and melting were also reported. This study showed that good quality orange seed oils can be produced by cold pressing, and the oils could be used in food and non-food applications.

MPV, NLR, and platelet count: new hematologic markers in diagnosis of malignant ovarian tumor

OBJECTIVE

Evaluation of mean platelet volume (MPV), neutrophil to lymphocyte ratio (NLR), and platelet count in the detection of malignant and benign ovarian tumors.

MATERIAL AND METHODS

Sixty-six patients admitted to the present clinic over three years were in- cluded in the study. Patients diagnosed with ovarian cancer were grouped into the areas of epithelial and granulosa cell tumor diagno- sis. The values were compared to patients with benign cystic structure. Patients' preoperative hematologic parameters and their values four weeks postoperatively were analyzed. Statistical analyses were performed with SPSS software.

RESULTS

MPV, NLR, and platelet count were observed at a higher rate as statistically significant in patients diagnosed with malignant ovarian cancer, compared to those with benign adnexal mass.

CONCLUSION

The hemnatological parameters such as MPV, NLR, and platelet count in the detection of malignant ovarian tumors have been evaluated as useful new markers.

[The acetabulum nonunion: reconstruction and reosteosynthesis : A long-term outcome]

Acetabular nonunions are rare, especially after operative treatment of an acetabular fracture. There are only single reports of the reconstruction and therapy of acetabular nonunion. Furthermore, there are fewer reports for treatment of acetabular nonunion with a long follow-up. We report a successful revision of an acetabular nonunion after transversal fracture and previous operative intervention, as well as the long-term follow-up after revision surgery.