Accurate diagnosis of COVID-19 from lung CT images using transfer learning

OBJECTIVE

In this study, it is aimed to classify data by feature extraction from tomographic images for the diagnosis of COVID-19 using image processing and transfer learning.

MATERIALS AND METHODS

In the proposed study, CT images are made better detectable by artificial intelligence through preliminary processes such as masking and segmentation. Then, the number of data was increased by applying data augmentation. The size of the dataset contains a large number of images in numerical terms. Therefore, the results of the models are more reliable. The dataset is split into 70% training and 30% testing. In this way, different features of the applied models were found, and positive effects were achieved on the result. Transfer Learning was used to reduce training times and further increase the success rate. To find the best method, many different pre-trained Transfer Learning models have been tried and compared with many different studies.

RESULTS

A total of 8,354 images were used in the research. Of these, 2,695 consist of COVID-19 patients and the remaining healthy chest tomography images. All of these images were given to the models through masking and segmentation processes. As a result of the experimental evaluation, the best model was determined to be ResNet-50 and the highest results were found (accuracy 95.7%, precision 94.7%, recall 99.2%, specificity 88.3%, F1 score 96.9%, ROC-AUC score 97%).

CONCLUSIONS

The presence of a COVID-19 lesion in the images was identified with high accuracy and recall rate using the transfer learning model we developed using thorax CT images. This outcome demonstrates that the strategy will speed up the diagnosis of COVID-19.

The roles of Klotho and FGF-23 in bipolar manic episode

OBJECTIVE

Bipolar disorder (manic episode) is an essential psychiatric disorder with unknown etiology, in which inflammation is considered to play a role. Klotho and FGF-23 are known to be associated with inflammation. Therefore, this study aimed to determine the link between Klotho and FGF-23 levels and bipolar disorder.

PATIENTS AND METHODS

In this study, 42 men with BD and 41 healthy controls were enrolled, followed up, and/or treated at the High-Security Forensic Psychiatry Clinic. Sociodemographic data form, Young Mania Rating Scale, and Hamilton Depression Rating Scale were applied to all participants.

RESULTS

Klotho and FGF-23 levels were significantly increased in patients with BD manic episodes. There was no correlation between Klotho and FGF-23 levels and clinical parameters. For Klotho and FGF-23, cutoff values of 69 and 1,646 yielded 67.4% sensitivity and 72.1% specificity and 81.4% sensitivity and 51.2% specificity, respectively.

CONCLUSIONS

Klotho and FGF-23 may play critical roles in the etiopathology of manic episodes and are potential candidate biomarkers for bipolar disorder. This relationship might contribute to the etiopathogenesis of the disease and determine its treatment. Anti-Klotho and anti-FGF-23 administration may be a future treatment for controlling the course of the disease.

Subfatin, asprosin, alamandine and maresin-1 in cerebral ischemia, intracranial and subarachnoid hemorrhages

OBJECTIVE

Cerebrovascular diseases (CVDs) remain an important public health issue due to the increasing number of deaths worldwide. Changes in the synthesis and release of peptides in CVDs may play an important role in elucidating the physiopathology of the disease. Therefore, this study was to investigate the fate of maresin-1 (MaR-1), subfatin (SUB), asprosin (ASP), and alamandine (ALA) levels in patients with cerebral infarction (CI), intracranial hemorrhage (ICH), subarachnoid hemorrhage (SAH) evaluated within the scope of CVDs, and voluntary healthy controls.

PATIENTS AND METHODS

The study participants were divided into 4 groups: CI patients, ICH patients, SAH patients, and healthy volunteers. The diagnosis of CVDs was made based on the National Institutes of Health Stroke Scale (NIHSS), Intracerebral Hemorrhage Score (ICHS), Botterel-Hunt-Hess Scale (BHHS), and cranial computed tomography (CT). The levels of MaR-1 (ng/mL), SUB (ng/mL), ASP (ng/mL), and ALA (pg/mL) in the blood samples collected from the participants were studied using the ELISA method. Other parameters included in the study were obtained from the patient records of our hospital.

RESULTS

The comparison of MaR-1 [(control 1.38 ± 0.14), SAH (0.98 ± 0.087), CI (0.67 ± 0.04), ICH (0.51 ± 0.03)], SUB [(control (13.2 ± 1.4), SAH (10.1 ± 1.2), CI (7.9 ± 0.8), ICH (5.8 ± 0.5)], and ALA [(control (67.2 ± 7.9), SAH (58.2 ± 4.3), CI (42.1 ± 3.7), and ICH (34.2 ±3.9)] values revealed a significant decrease compared to the control values. The comparison of the ASP values of SAH, CI, and ICH patients and control values (11.6 ± 1.2) showed significantly higher asprosin values in SAH (13.8 ± 1.1), CI (15.4 ± 1.2) and ICH (28.9 ± 2.8) patients. Similarly, systolic blood pressure (SBP), diastolic blood pressure (DBP), and glucose levels of CKD patients were also high.

CONCLUSIONS

Decreased MaR-1, SUB, ALA and increased ASP compared to the control values may play a role in the physiopathology of these diseases. MaR-1, SUB, ALA, and ASP differences between SAH, CI and ICH patients may also guide clinicians along with SBP, DBP and glucose values.

Informative value of referral letters from general practice for child and adolescent mental healthcare

Although referral letters (RLs) form a nodal point in a patient's care journey, little is known about their informative value in child and adolescent mental healthcare. To determine the informative value of RLs to child and adolescent psychiatry, we conducted a chart review in medical records of minors registered at specialized mental healthcare between January 2015 and December 2017 (The Netherlands). Symptoms indicated in RLs originating from general practice (N = 723) were coded and cross-tabulated with the best estimate clinical classifications made in psychiatry. Results revealed that over half of the minors in the sample were classified in concordance with at least one reason for referral. We found fair to excellent discriminative ability for indications made in RLs concerning the most common psychiatric classifications (95% CI AUC: 60.9-70.6 for anxiety disorders to 90.5-100.0 for eating disorders). Logistic regression analyses suggested no statistically significant effects of gender, age, severity or mental healthcare history, with the exception of age and attention deficit hyperactivity disorders (ADHD), as RLs better predicted ADHD with increasing age (OR = 1.14, 95% CI 1.03-1.27). Contextual problems, such as difficulties studying, problems with parents or being bullied were indicated frequently and associated with classifications in various disorder groups. To conclude, general practitioners' RLs showed informative value, contrary to common beliefs. Replication studies are needed to reliably incorporate RLs into the diagnostic work-up.

Vitamin D supplementation alleviates diabetic complications by increasing the amount of irisin in testicular tissues and blood of rats with experimental diabetes

OBJECTIVE

Diabetes is an important endocrinological disease that has an increasing incidence in the world and affects all biological tissues including testicles. Therefore, this study aimed to reveal the histological and biochemical effects of vitamin D on irisin, apoptosis, total antioxidant status (TAS), and total oxidant status (TOS) in testicular tissues of rats with experimental diabetes.

MATERIALS AND METHODS

41 male Wistar rats, 8-10 weeks old, weighing between 200-220 g, were included in the study as the following groups: control group (n=7; no treatment), sham group [only sodium citrate buffer (SCB)] [n=7; single dose 0.1 Molar (M) SCB given intraperitoneally (i.p)], vitamin D group (n=7; 50 IU/day given orally), diabetes group [n=10; single dose 50 mg/kg Streptozotocin (STZ) dissolved in 0.1 M SCB and given i.p (tail vein blood glucose level above 250 mg/dl after 72 hours)] and diabetes+vitamin D group [n=10, single dose 50 mg/kg STZ, dissolved in 0.1 M SCB and given i.p (tail vein blood glucose level above 250 mg/dl after 72 hours) and when diabetes occurs, oral vitamin D administration of 50 IU/day)]. At the end of the 8 weeks experiment, blood was drawn from the tail vein of all rats, they were sacrificed and testicular tissues were taken. While the amount of irisin in the blood and testicular tissue supernatants was analyzed with the Enzyme-Linked Immunosorbent Assay (ELISA) method, TAS and TOS measurements were analyzed with the REL method, testicular tissues were analyzed histopathologically, immunohistochemically, and with the TUNEL method.

RESULTS

When the diabetes group was compared with the control and sham groups, it was reported that the amounts of blood and tissue supernatant irisin and TAS significantly decreased and the TOS was significantly increased; a statistically significant increase in irisin and TAS of blood and tissue supernatants and a significant decrease in TOS were detected when diabetes+vitamin D and diabetes groups were compared among themselves. Similar results were obtained in the immunohistochemical studies. Tissue expressions of irisin decreased in the diabetes group compared to the control and sham groups, while the application of vitamin D increased the tissue expressions of irisin. Additionally, when the numbers of apoptotic cells were compared, it was reported that apoptotic cells in the diabetes group increased significantly compared to the control and sham groups, and vitamin D administration significantly decreased the number of apoptotic cells.

CONCLUSIONS

Taken together, vitamin D administration to diabetic rats decreased the number of apoptotic cells and increased the amount of irisin. Vitamin D had an effective role in maintaining the physiological integrity of rat testicular tissues, so vitamin D may be a potent agent to be used in the treatment of diabetes in the future.

Effects of oxygen saturation on the hypoxia-inducible factor-1α, subfatin, asprosin, irisin, c-reactive protein, maresin-1, and diamine oxidase in diabetic patients with COVID-19

OBJECTIVE

Oxygen is essential for living organisms that perform aerobic respiration since cells begin to die when humans and animals are deprived of oxygen. Oxygen saturation decreases and shortness of breath occurs in coronavirus (COVID-19) disease. Therefore, in this study, we aimed to determine the changes in hypoxia-inducible factor-1α (HIF-1α), subfatin, asprosin, irisin, C-reactive protein (C-RP), Maresin-1 (MaR-1), and diamine oxidase (DAO) molecules in diabetic patients with coronavirus according to their oxygen saturations.

PATIENTS AND METHODS

Participants were classified into 4 Groups of 22, including patients with oxygen saturation between 95% and 100% (Group I, control), between 80% and 85% (Group II), between 75% and 79% (Group III), and between 70% and 74% (Group IV). COVID-19 was diagnosed with PCR testing and 5 mL of blood was taken following the diagnosis. HIF-1α, subfatin, asprosin, irisin, MaR-1, and DAO values of the participants were measured with ELISA. Other parameters used in the study were obtained from the records of the patients.

RESULTS

When Group I was compared to Groups II, there was no significant change in Group II while HIF-1α, subfatin, asprosin, irisin, C-RP, and DAO counts had increased significantly in Groups III and IV. When the MaR-1 values were examined, they were reported to have decreased significantly in Groups III and IV (p < 0.05). Similarly, when Group II and Group IV were compared, HIF-1α, subfatin, asprosin, irisin, C-RP, and DAO values of the participants in Group IV had significantly increased while MaR-1 values had significantly decreased (p < 0.05). In the case of oxygen saturation decreasing below the critical value (70-74%) in patients with coronavirus, the release of HIF-1HIF-1α, subfatin, asprosin, irisin, C-RP, and DAO increased while the MaR-1 values decreased (p < 0.05).

CONCLUSIONS

Changes in these molecules in patients with coronavirus and diabetes according to their oxygen saturation suggested that they functioned as the "metabolic oxygen sensors" of the metabolism. Therefore, according to these data, it was predicted that these molecules had the potential to be used in the diagnosis and follow-up of diseases related to oxygen (such as asthma, and critical intensive care patients) in clinics in the future.

The shortest distance between the skin and the peritoneal cavity is obtained with fascial elevation: a preliminary prospective laparoscopic entry study

The purpose of this study was to prospectively compare the measurement of skin-to-fascia distances in the neutral state, during manual elevation and by fascial elevation in patients who underwent laparoscopic surgery. In 53 patients, the distance between the skin and anterior wall of the rectus sheath was measured prospectively in following three different ways: (1) in neutral position, (2) during manual elevation and (3) during elevation of the fascia using forceps following an infraumbilical vertical skin incision. In all patients, subcutaneous tissue up to the fascia was dissected after a vertical skin incision. The skin-to-fascia distance of 30.9 mm (14.0-52.0 mm) in the neutral position decreased to 11.1 mm (0.0-26.0 mm) during the fascial elevation, while the mean distance increased to 40.1 mm (19-70 mm) during manual elevation (p < 0.001). In the closed laparoscopic entry technique in which a Veress needle is inserted into the peritoneum through a small incision, the needle should be introduced from the shortest distance between the skin and the peritoneum. Lifting the fascia with a proper surgical instrument in suitable patients could enable us to achieve this goal.

Irisin, Angtpl8, Elabela and antioxidants alteration in rats with and without energy drink and treadmill exercise

OBJECTIVE

In this study, we sought to investigate the effects of energy drink supplementation and treadmill exercise on the levels of free radicals, antioxidants, Angtpl8, Elabela, and lipid metabolism in rats.

MATERIALS AND METHODS

A total of 28 male Wistar albino rats (4 weeks old, 101.96 ± 9.75 g) were included in the study. The rats were randomly divided into four equal groups: control, exercise, supplement, and exercise+supplement groups. At the end of the study, the rats were decapitated, and blood samples were tested for levels of Angptl-8, ghrelin, leptin, irisin, SOD, CAT, TBARS, total oxidant status, and total antioxidant status using enzyme-linked immunosorbent assay. Levels of blood lipids including triglycerides, total cholesterol, HDL-C, and LDL-C were studied using spectrophotometric method in an auto analyzer.

RESULTS

Statistical analysis showed statistical significance in TBARS, LDL-C, irisin, Angptl-8, and Elabela levels of the exercise group; SOD and HDL-C levels of the supplement+exercise group; and total cholesterol levels in the supplement group (p < 0.05). Although there were differences between the groups in leptin, ghrelin, and CAT levels, they were not statistically significant (p > 0.05).

CONCLUSIONS

As a result, it can be argued that treadmill exercise is important in regulating lipid metabolism and stimulating peptide hormones and receptors. Furthermore, consuming energy drinks without performing exercise or physical activity increases fat stores, and such increases in the critical organs and tissues may pose a threat to the body.

POS0004 WHAT DOES WORSENING IN DAPSA DISEASE ACTIVITY CATEGORIES MEAN FOR PATIENTS WITH PSORIATIC ARTHRITIS? AN ANALYSIS OF 222 PATIENTS

Background

In psoriatic arthritis (PsA), disease activity states have been defined using the DAPSA (Disease Activity index for Psoriatic Arthritis) score (1). The disease activity states have been validated using structural progression as the gold standard (2). However, the worsening in DAPSA states has not been compared to the patient’s perspective.

Objectives

To assess the association between a worsening in disease activity (i.e., change in DAPSA disease activity category) versus the patient’s judgement of disease worsening.

Methods

ReFlap (NCT03119805) was a longitudinal study in 14 countries of consecutive adult patients with definite PsA and more than 2 years of disease duration. Patients were seen twice in the context of usual care, around 4 months apart (3). Worsening in disease activity between the 2 visits was defined as a transition to a more active disease category, based on the DAPSA categories [(remission, low disease activity (LDA), moderate disease activity (MDA) and high disease activity (HDA)] (1).This change was compared to (a) patient perceived-flares collected according to a patient-reported question: “At this time, are you having a flare of your psoriatic arthritis, if this means the symptoms are worse than usual?”; and (b) a worsening according to the MCID (Minimal Clinical Important Difference) question. The agreement between the definitions of worsening were calculated by frequency, Cohen’s kappa and prevalence adjusted bias adjusted kappa (PABAK). There was no imputation of missing data.

Results

Overall, 222 patients were analyzed: 127 (58.8%) were male, aged 53.5±12.3 years and with 10.8±8.3 years of disease duration. Disease activity was moderate: 35.9% had no current psoriasis skin lesions, mean tender joint count (TJC, 0-68) was 3.0±7.5, mean swollen joint count (SJC, 0-66) was 1.6±6.6, and mean DAPSA was 11.5±14.0.

At 4.5±2.2 months follow-up, the proportion of DAPSA worsening was 40.1% [95% confidence interval, 33.9-46.7] (n=89). Most of the changes corresponded to patients going from remission to LDA (N=24, 27.0% of worsened patients) or from LDA to MDA (N=24, 27.0%).

Patient-reported flares were reported in 27.0% [21.6-33.2] (n=60), and MCID worsening was reported in 14.0% [33.9-46.5] (n=31).

Figure 1 shows the distribution of patients with worsening in DAPSA category, versus patient-defined worsening. Of the 89 patients who worsened according to DAPSA categories, 41 (46.1%) had self-perceived flares and 20 (22.5%) had worsening according to MCID. Among patients who worsened in DAPSA category, the mean change in DAPSA was higher in patients with self-perceived flares (increase of 22.2±15.0) than in patients without self-perceived flares (increase of 14.3±12.3). Of 133 patients with no worsening according to DAPSA, 114 (85.7%) had no self-perceived flares and 122 (91.7%) had no MCID worsening. The kappa [95% confidence interval] (PABAK) coefficients between DAPSA and either patient flare or MCID worsening were 0.34 [0.21-0.46] (0.40) and 0.16 [0.05-0.27] (0.28), respectively.

Figure 1.

Venn diagram for disease worsening between 2 visits

Conclusion

After 4 months of follow-up, 40.1% patients with long-standing PsA had a change in DAPSA category corresponding to more active disease. Most of these changes reflected transitions from remission to LDA, or from LDA to MDA. Among patients changing DAPSA category, only 46.1% reported themselves in flare at the second visit and only 22.5% reported themselves as worsened by MCID, leading to only fair (for flares) to low (for MCID worsening) agreement between the assessments of worsening. It is important to assess both disease activity, and the patient’s perspective of flare.

References

[1]Schoels M, et al. Ann Rheum Dis. 2016;75(5):811-8.

[2]Aletaha D, et al. Ann Rheum Dis. 2017;76(2):418-421.

[3]Gorlier C, et al. Ann Rheum Dis 2019;78:201-208.

Disclosure of Interests

None declared

Molecular communication between Apelin-13, Apelin-36, Elabela, and nitric oxide in gestational diabetes mellitus

OBJECTIVE

Gestational diabetes mellitus (GDM) is a type of diabetes that affects from 3.8% to 6.9% of pregnancies worldwide, causing significant mortality and unfavorable obstetric outcomes, such as delivery trauma and macrosomia risk. The fundamental processes of this metabolic disorder that first appeared during pregnancy are still unknown. Tissue hormones, particularly adipokines, have aided in understanding the pathophysiology of numerous disorders in recent years. This study aims to determine if Apelin-13 (APLN-13), Apelin-36 (APLN-36), Elabela (ELA), and nitric oxide (NO) molecules have all a part in the pathophysiology of GDM.

PATIENTS AND METHODS

The study included 30 pregnant control women and 30 pregnant women who had been diagnosed with GDM in the second trimester and whose body mass index and age were compatible with each other. Blood samples were collected from 60 participants during the second trimester (30 control pregnant women and 30 GDM pregnant women) and postpartum (17 controls vs. 14 GDM). In these blood samples, the amounts of APLN-13, APLN-36, ELA, and NO were studied using the ELISA method. In addition, the participants' glucose, lipid profiles, and other parameters were obtained from the hospital record files. At postpartum, 29 pregnant women (13 control and 16 pregnant women with GDM) dropped out of the study without explanation.

RESULTS

In the second trimester and postpartum plasma of mothers with GDM, APLN-13, APLN-36, NO, and ELA molecules were found to be significantly higher (< 0.05), compared to those of the control mothers, while APLN-13, APLN-36, NO values were significantly lower (0.05). While APLN-13, APLN-36, NO amounts in mothers with GDM were positively correlated with glucose amounts, they were negatively correlated with ELA amounts. Similarly, the triglyceride amounts in mothers with GDM were positively correlated with APLN-13, APLN-36 and NO, while they were negatively correlated with the ELA amounts. Due to gestational diabetes, APLN-13, APLN-36, NO, glucose, and triglyceride increased, and ELA decreased.

CONCLUSIONS

It is predicted that the glucose increase in GDM is because Apelins reduce glucose transport to erythrocytes by inhibiting the sodium-dependent glucose transporter (SGLT) and that the increase in triglyceride and NO may be associated with high glucose levels in GDM. As a result, we believe that the above-mentioned chemicals may cause GDM Pathology by triggering one another.

Effect of regular exercise on the levels of subfatin and asprosin: a trial with different types of exercise

OBJECTIVE

Subfatin (Metrnl) and asprosin are associated with metabolic diseases, such as obesity and diabetes. Exercise is among the most important regulators of health in humans and has been previously demonstrated to regulate these parameters. The present study aimed to investigate the effects of different types of regular exercises on levels of subfatin, asprosin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), uric acid, and glucose.

MATERIALS AND METHODS

The study included 120 young and healthy males, who participated in the study voluntarily. These participants were randomly divided into four groups, such as control (C), aerobic exercise (AE), intermittent (HIIT), and resistance exercise (RE) groups. Additionally, all the groups had equal numbers of participants. First, the subjects in the exercise group were made familiar with the exercise regime for two weeks. Then, they performed regular exercises, three days a week for eight weeks. Blood samples were collected from the participants at the beginning and end of the study. Subfatin and asprosin levels were analyzed using the ELISA method. AST, ALT, uric acid, and glucose levels were analyzed using the AutoAnalyzer.

RESULTS

No differences were observed in pretest values between the groups (p>0.05). Assessment of intragroup changes demonstrated no significant changes in the control group. In the comparisons, statistically significant changes were recorded in the levels of subfatin, asprosin, and glucose in all exercise groups. Particularly, differences were observed in the levels of AST and uric acid in the AE and HIIT groups while differences in ALT levels were observed only in the AE group (p<0.05).

CONCLUSIONS

In the conclusion of the study, different types of exercises caused significant changes in subfatin and asprosin levels. Thus, these results suggested that the parameters associated with metabolic diseases could be controlled with the aid of regular exercises.

Basal blood concentrations of some orexigenic and anorexigenic hormones in obese and nonobese individuals according to blood groups

OBJECTIVE

Obesity is a serious public health problem associated with excessive food intake. Regulation of food intake in highly organized organisms is under the control of a large number of orexigenic and anorexigenic molecules. Therefore, the main purpose of this study has been to determine the relationship between obesity and some of the circulating orexigenic and anorexigenic peptides that have a role in appetite control and to determine whether the concentrations of these molecules differ according to blood groups.

PATIENTS AND METHODS

The study included 400 individuals of whom 100 were obese women, 100 obese men, 100 healthy men and 100 healthy women. Obese women and men were divided into 4 groups, according to their blood groups. In the control group, healthy women and healthy men were similarly divided into 4 blood groups. Each blood group within the groups, therefore, had 25 participants.

RESULTS

When leptin, nesfatin-1, obestatin and neuropeptide-Y, ghrelin and galanin levels of the control group and obese participants were compared, regardless of blood groups, leptin, nesfatin-1, obestatin and neuropeptide-Y were significantly higher, whereas only the ghrelin levels were significantly lower in obese patients. When the amounts of these hormones were measured according to gender, the situation was similar. When leptin, nesfatin-1, obestatin and neuropeptide-Y values of the control and obese participants' blood groups were compared with each other; these hormones were high in all blood groups; however, leptin levels in A blood group, nesfatin-1 levels in AB and O blood group, obestatin levels in AB blood group, neuropeptide-Y levels in A, B, AB blood groups were significantly higher. When the ghrelin levels of the blood groups in the control group and obese participants were compared, it was only significantly lower in the AB blood group. The ghrelin levels in the other blood groups of the obese individuals were again low, but not significantly so. When the distribution of hormones according to gender was evaluated, a situation parallel to the above results was recorded.

CONCLUSIONS

Leptin, nesfatin-1, obestatin and neuropeptide-Y and galanin levels of obese individuals were significantly higher than the control values, whereas the ghrelin values were significantly lower regardless of blood groups. Also, these hormones in blood partly varied with ABO blood groups. These different concentrations of hormones in ABO blood groups might be related with stimulation or suppression of appetite in human. However, further studies in other ethnic groups are needed to confirm these results.

Leptin/Melanocortin pathway hormones in obese patients after laparoscopic sleeve gastrectomy

OBJECTIVE

The melanocortin system is an important neural system underlying the control of body weight and food intake. This system has recently received great attention as a potential target for obesity treatment. Therefore, the objective of this study was to find out the leptin-melanocortin pathway before and after Laparoscopic Sleeve Gastrectomy (LSG) in obese patients.

PATIENTS AND METHODS

The study was carried out with a total of 144 individuals in 3 groups [control, obese group before LSG and obese group after LSG (who underwent LSG one year ago)]. The amount of leptin (LEP), leptin receptor (LEPR), tropomyosin receptor kinase receptor B (TrkB), brain-derived neurotrophic factor (BDNF), pro-opiomelanocortin (POMC) and melanocortin-4 receptors (MC4R) molecules were measured by using Enzyme-Linked Immunosorbent Assays.

RESULTS

A statistically significant difference was found between the groups in terms of body mass index (BMI) values (p = 0.001). There was also statistically significant difference present between obese before LSG group and obese after LSG group regarding the levels of LEP, TrkB, BDNF and proteins (p < 0.05). A decline was determined in the LEP and BDNF levels one year follow-up after LSG.

CONCLUSIONS

The evidence suggests that the leptin melanocortin pathway strictly regulates food intake and BMI before and after LSG surgery. This pathway should be kept under control for effectively reducing food intake and body weight in the treatment of obesity.

The morphology of fabella and its prevalence in Turkish society

OBJECTIVE

Fabella is a sesamoid whose prevalence is unstable and can be found as bone or cartilage, which changes over time. This study aims to reveal the prevalence, distribution, gender differences, and morphometric characteristics of cartilage and bony fabella in the Turkish population.

PATIENTS AND METHODS

The study included 2.035 individuals over 18 years of age. MR images of 121 individuals, whose MR images of both knees could be obtained by anteroposterior and lateral radiographs of the participants, were evaluated retrospectively.

RESULTS

The prevalence of fabella was 39.6% in females, 38.4% in males, and 38.8% in total. The prevalence of cartilage fabella was 9.1%, whereas bone fabella incidence was 29.7% regardless of gender. The fabella's mean thickness, width, length, and distance to the epicondylus lateralis femoris were 3.84 mm, 6.04 mm, 6.23, and 31.26 mm, respectively.

CONCLUSIONS

The data of this study showing the occurrence and morphometric characteristics of bony and cartilaginous fabella allow early and accurate diagnosis of various pathological conditions caused by fabella.

Could the Prevalence and Distribution of Os Supratrochleare Dorsale and Patella Cubiti be the Key to Accurate Diagnosis?

BACKGROUND

The aim of this study was the prevalence of patella cubiti and os supratrochleare dorsale, and to detect the differences between genders.

MATERIALS AND METHODS

In the study, direct radiographs of 1646 people (959 females and 687 males), who presented to Fırat University Hospital between 01.01.2016 and 31.01.2019 and had elbow joint radiographs, were evaluated retrospectively. Of the radiographs evaluated, 346 were right and left elbow radiographs of the same people, 689 were just right elbow radiographs, and 611 were only left elbow radiographs.

RESULTS

The prevalence of os supratrochleare dorsale was 2.08% (20 in 959 women) in women, 2.62% (18 in 687 men) in men, and 2.3% (38 in 1646 people) in total. The prevalence of patella cubiti was found to be 0.42% (4 in 959 women) in women, 1.31% (9 in 687 men) in men, and 0.79% (13 in 1646 people) in total. In addition, the prevalence of both sesamoid bones only in the left elbow and in both elbows was determined with and without separation according to male-female genders.

CONCLUSION

We are of the opinion that knowing the prevalence and distribution of these sesamoid bones will help with establishing early and correct diagnoses for patients who present with complaints, such as elbow extension limitation and pain in the elbow area.

P–273 Effects of ovulation induction with GnRH Agonist (GnRHa) on oocyte and embryo quality at the mitochondrial level: A retrospective and experimental study

Study question

Does the GnRHa trigger improve oocyte and embryo quality in patients younger than 40, and do mtUPPR have a role?

Summary answer

GnRHa trigger improves oocyte nuclear/cytoplasmic maturation, blastocyst utilization and downregulates HSP60 levels and upregulates ATF5 levels compared to hCG trigger. GnRHa trigger suppresses mitochondrial stress.

What is known already

hCG has been used for decades to achieve final oocyte maturation and, thereby, correct oocyte retrieval timing in connection with ovarian hyperstimulation protocols. As an alternative to hCG, a GnRH agonist has been used to trigger the endogenous release of LH (and FSH) in a fashion resembling the mid-cycle surge of gonadotrophins. GnRHa is as effective as hCG for the induction of ovulation. It has been very well known that the GnRHa trigger improves oocyte nuclear maturation, embryo quality, and implantation rate, but the underlying mechanism remains unknown.

Study design, size, duration

3054 women younger than 40; oocytes retrieved more than 10 (up to 20) analyzed. Male infertility was excluded. Ovulation triggered either by hCG (n = 1368) or GnRHa (1668). Female mice were divided into three groups as control, hCG-treated and GnRHa-treated group. Superovulation was performed by FSH + hCG or GnRHa. Oocytes were collected 13 hours after hCG/GnRHa injection. ATF5, BiP, and HSP60 levels were analyzed by Western blot. Statistical analysis was performed using Student’s t-test.

Participants/materials, setting, methods

This study has two parts. i) RCT and ii) Experimental. In the experimental part, three months old female BALB/C mice (25–30 g) were used and divided into three groups (n = 20/group) as control, hCG-treated and GnRHa-treated group. Superovulation was performed by administering an injection of 5 IU FSH (i.p.) and hCG (i.p.) or GnRHa (20 mg/kg) i.m. Oocytes were collected 13 hours after hCG/GnRHa injection. ATF5, BiP, and HSP60 levels were analyzed by Western blot.

Main results and the role of chance

The mean age (34.8 vs. 35.2 years), total gonadotropin dose (2176 vs. 2230 IU), and the number of oocytes picked up (14.9 vs. 13.4) were not statistically different among GnRHa and hCG group, respectively. No LH rise or any OHSS was noticed in any groups.

Oocyte maturation (79.8% vs. 75.9%), oocyte diameter (as a marker of cytoplasmic maturity) (10198 µm2 and 9474 µm2), fertilization rate (78% vs. 72%), and embryo utilization rate (52% vs. 47.2%) were significantly higher in GnRHa group compared to hCG group, respectively.

HSP60 level (activated by mtUPR) was statistically higher in the hCG group compared to the GnRHa group (55% vs. 22%, p &lt; 0.05 respectively). On the other hand, the ATF5 level was significantly higher in the GnRHa group than the hCG group (p &lt; 0.0001).

Limitations, reasons for caution

The limitation is that this is a proof-of-concept study to reveal the mechanism of good embryo quality with GnRHa trigger.

Wider implications of the findings: This application offers convenience and simplifies the IVF protocol with a better oocyte and embryo quality while reducing Ovarian Hyperstimulation Syndrome (OHSS) risk during IVF care

Trial registration number

Not applicable

AB0373 PSYCHOMETRIC PROPERTIES OF OUTCOME MEASUREMENT INSTRUMENTS FOR LARGE VESSEL VASCULITIS: A SYSTEMATIC LITERATURE REVIEW

Background:

Giant cell arteritis (GCA) and Takayasu arteritis (TAK) are two forms of chronic progressive large-vessel vasculitis (LVV) of unknown etiology. In 2016, the OMERACT Vasculitis Working Group proposed the development of a Core Domain Set of outcome measures for LVV including organ and arterial function, fatigue, pain, biomarkers, and death (1). Understanding the psychometric properties of outcome measurement instruments is essential when selecting among instruments to use in research; a summary of such properties for measures of LVV has not been developed.

Objectives:

To systematically review and summarize the psychometric properties of outcome measurement instruments used to measure the domains of the OMERACT core domain set for LVV.

Methods:

A comprehensive search of several databases (Medline, EMBASE, Cochrane, among others) from inception to July 14, 2020 was conducted. Articles were included if they covered psychometric properties of instruments used in LVV. Following the COSMIN and OMERACT frameworks, different psychometric properties (validity, inter- and intra-observer reliability, sensitivity to change, and feasibility) of outcome measurement instruments used in LVV (GCA and TAK) were assessed. Risk of bias was assessed according to the COSMIN checklist.

Results:

Among the 3534 articles identified, 15 studies focusing on the development or validation of psychometric properties on LVV met the predefined criteria. Two were development studies and 13 were validation studies. These studies provided information on 13 instruments: 5 instruments specific to TAK, 2 specific to systemic vasculitides, and 6 general, non-disease-specific instruments. No instruments specific to GCA were identified.

Of the main psychometric properties assessed in the included studies, 40% had a low, 47% had moderate, and 13% had high risk of bias. Construct validity was the property most frequently assessed (in 93% of the tools) (Figure 1).

In TAK, the Indian Takayasu Clinical Activity Score 2010 (ITAS2010) showed good consistency (r=0.97), reliability (intra-observer, ICC=0.60; inter-observer, ICC=0.92) and validity (correlation with Physician Global Assessment (PGA) (r=0.73)) for disease activity. Regarding disease damage, the Disease Extent Index-Takayasu (DEI-Tak) showed good validity (correlation with NIH score 94%, k=0.85). Non-specific vasculitis instruments such as the Vasculitis Damage Index (VDI) and the Birmingham Vasculitis Activity Score (BVAS) showed moderate validity in the assessment of disease damage in GCA (cumulative glucocorticoid dose and disease duration, r=0.30 and r=0.29) and TAK (cumulative glucocorticoid dose and disease duration, r=0.29 and r=0.25) in the former and disease activity in GCA in the later (PGA, r=0.50).

Six non-vasculitis-specific patient-reported outcomes (PROs) instruments were identified, all showing low to moderate validity in GCA/TAK.

Conclusion:

The psychometric properties of 13 outcome measures to study LVV covering the OMERACT domains of disease activity, damage, and patient-reported outcomes were assessed. ITAS2010, DEI-Tak, VDI, and BVAS were the instruments with better psychometric properties for disease activity and/or damage. Disease activity and/or damage instruments specific for GCA, and validated PROs for both GCA and TAK are needed.

References:

[1]Sreih GA, Alibaz-Oner F, Kermani TA, Aydin SZ, Cronholm PF, Davis T, et al. Development of a Core Set of Outcome Measures for Large-vessel Vasculitis: Report from OMERACT 2016 | The Journal of Rheumatology [Internet]. [cité 26 avr 2020]. Disponible sur: http://www.jrheum.org/content/44/12/1933.long

Disclosure of Interests:

None declared

POS0037 DOES IMAGING OF THE SACROILIAC JOINT DIFFER IN PATIENTS PRESENTING WITH UNDIAGNOSED BACK PAIN AND PSORIASIS, ACUTE ANTERIOR UVEITIS, AND COLITIS: AN INCEPTION COHORT STUDY

Background:

Axial spondyloarthritis (axSpA) presents diagnostic challenges incurring a delay of up to a decade and relies considerably on radiographic and MRI evidence of sacroiliitis which has led to the development of classification criteria which also rely on imaging. However, it has been suggested that such criteria may not be appropriate for axSpA patients presenting with other forms of SpA, especially psoriatic, because imaging features may vary in frequency and/or may be atypical. This hypothesis has never been tested in a prospective inception cohort of patients presenting with undiagnosed back pain.

Objectives:

We aimed to compare the spectrum of radiographic and MRI abnormalities in the sacroiliac joint (SIJ) of an inception cohort of patients presenting with undiagnosed back pain and psoriasis, iritis, and colitis.

Methods:

We used data from the prospective multicenter Screening for Axial Spondyloarthritis in Psoriasis, Iritis, and Colitis (SASPIC) Study, which is aimed at early detection of axial SpA in patients referred by the respective specialist after first presenting with these disorders. Consecutive patients ≤45 years of age with ≥3 months undiagnosed back pain with any one of psoriasis, AAU, or colitis undergo routine clinical evaluation by a rheumatologist for axial SpA followed by imaging. In SASPIC I, MRI evaluation of the SIJ was ordered per rheumatologist decision. In SASPIC II, MRI evaluation was ordered for all patients. Radiographs and MRI scans were assessed by two central readers and comparisons of the three groups were based on concordant assessments of imaging features. Evaluation of MRI scans included both global assessment for presence/absence of axSpA with confidence scale (-10 to +10), active and structural lesions typical of axSpA per recent ASAS definitions, and granular assessment of individual lesions according to SIJ quadrants and halves in consecutive semicoronal slices through the SIJ. Groups were compared by ANOVA and the chi-square test.

Results:

A total of 240 patients were recruited, 143 from SASPIC I and 97 from SASPIC II, 101 (42.1%) being diagnosed with axSpA (65.3% male, mean age 34.4 years, mean symptom duration 8.7 years, B27 positive 55.4%). Mean age of colitis (N=101), psoriasis (N=61), iritis (N=78) patients were 33.4, 36.6, 34.3 years, respectively, mean symptom duration was 6.8, 7.2, 9.4 years, respectively, and % males were 45.5%, 52.5%, 51.3%, respectively. There were no significant group differences for unilateral versus bilateral radiographic sacroiliitis and no significant differences in the frequencies, type, or distribution of MRI lesions (Table 1).

Conclusion:

Data from the SASPIC prospective inception cohort does not support the view that imaging of the SIJ differs in psoriatic axSpA, which appears similar to axSpA associated with iritis or colitis. These data support the umbrella concept of axSpA.

Imaging FeatureColitis (n=30)Psoriasis (n=19)Iritis (n=52)P valueUnilateral sacroiliitis (grade ≥2), N(%)1 (3.3%)0 (0%)2 (3.8%)0.69mNY criteria +, N(%)5 (16.7%)6 (31.2%)15 (28.8%)0.39Grade of sacroiliitis, mean(SD)1.8 (2.2)2.1 (2.7)2.2 (2.4)0.76MRI indicative of axSpA, N(%)15 (50.0%)11 (57.9%)32 (61.5%)0.60MRI indicative of axSpA (confidence ≥5/10), N(%)14 (46.7%)10 (52.6%)30 (57.7%)0.63MRI active lesion typical of axSpA, N(%)6 (20.0%)6 (31.6%)18 (34.6%)0.37MRI structural lesion typical of axSpA, N(%)11 (36.7%)7 (36.8%)18 (34.6%)0.98MRI with unilateral lesion (any)2 (6.7%)3 (15.8%)11 (21.2%)0.22MRI with unilateral lesion (BME)1 (3.3%)2 (10.5%)5 (9.6%)0.54MRI with unilateral lesion (Erosion)0 (0%)0 (0%)3 (5.8%)0.23MRI with unilateral lesion (Sclerosis)1 (3.3%)1 (5.3%)3 (5.8%)0.89MRI with unilateral lesion (Fat)0 (0%)0 (0%)0 (0%)NAMRI with iliac lesion17 (56.7%)12 (63.2%)32 (61.5%)0.88MRI with sacral lesion12 (40.0%)11 (57.9%)31 (59.6%)0.21

Disclosure of Interests:

Walter P Maksymowych Speakers bureau: Abbvie, Janssen, Novartis, Pfizer, UCB, Consultant of: Abbvie, BMS, Boehringer, Galapagos, Gilead, Lilly, Novartis, Pfizer, UCB, Grant/research support from: Abbvie, Novartis, Pfizer, Ulrich Weber: None declared, Jon Chan: None declared, Raj Carmona: None declared, James Yeung: None declared, Sibel Aydin: None declared, Jodie Reis: None declared, Liam Martin: None declared, Ariel Masetto: None declared, Olga Ziouzina: None declared, Dianne Mosher: None declared, Stephanie Keeling: None declared, Sherry Rohekar: None declared, Rana Dadashova: None declared, Joel Paschke: None declared, Amanda Carapellucci: None declared, Robert G Lambert: None declared.

OP0298 ARE PATIENTS WITH PSORIATIC ARTHRITIS BEING TREATED OPTIMALLY ACROSS THE WORLD? DISPARITIES IN HEALTH CARE FOR PATIENTS WITH PSORIATIC ARTHRITIS ACROSS COUNTRIES WITH DIFFERENT GDP’S, AN ANALYSIS OF 429 PATIENTS FROM 13 COUNTRIES

Background:

In psoriatic arthritis (PsA), EULAR recommendations are to aim for remission or low disease activity(1). Many treatments are now available, though some are costly and not widely available in all countries. Country of patient care, and in particular Gross Domestic Product (GDP) may be linked to PsA outcomes(2). Although patients with high disease activity are eligible for targeted therapies such as biologic disease-modifying anti-rheumatic drugs (bDMARDs), they may not be able to get the benefits from these efficacious treatments in all countries equally.

Objectives:

The objective was to explore the rate of PsA patients with high to moderate disease activity, not receiving bDMARDs across countries, and to assess the consequences on functional incapacity.

Methods:

This was a cross-sectional analysis of an observational study (ReFlap, NCT03119805)(3), which included adult patients with PsA with ≥ 2 years disease duration from 14 countries. One country was excluded from this analysis since only 7 patients were included. We explored the rate of patients with significant disease activity (i.e based on DAPSA > 14) and no ongoing bDMARD prescription. Countries of inclusion were analysed separately, and classified into tertiles by GDP/capita (lowest tertile: Brazil, Turkey, Russia, Romania, Estonia; middle tertile: Spain, Italy, UK, France; highest tertile: Canada, Germany, USA and Singapore). The rate of no bDMARDs - DAPSA > 14 patients was analysed by country and compared between the 3 tertiles of GDP/capita by parametric tests. Functional capacity (HAQ) was compared between no bDMARDs - DAPSA > 14 patients and the other patients (pooling patients with moderate or high disease activity with bDMARD, low disease activity and remission with or without bDMARD). There was no imputation of missing data.

Results:

Of the 459 patients, 429 had complete data available and were analysed: mean age 52.3 (SD 12.6) years, mean disease duration 10.2 (SD 8.2) years, 215 (50.1%) males. The rate of no bDMARDs - DAPSA > 14 patients was 18.4% (76/414). The rate ranged from 7.4% (UK and Spain) to 40% (Russia): Figure 1. A link was seen with the country and the tertiles of countries according to GDP/capita, with higher rate of no bDMARDs - DAPSA > 14 patients in the lowest GDP/capita countries (28.8%, 15.3% and 14.3% in the 3 GDP/capita tertiles, respectively, p=0.005; Figure 1). Of note, 40/76 no bDMARDs - DAPSA > 14 patients received a treatment intensification during the visit. Among no bDMARDs - DAPSA > 14 patients, functional incapacity was higher than in the other patients, as expected (mean HAQ 0.96 (SD 0.64) vs 0.57 (SD 0.63), p<0.001).

Figure 1.

The size of the bubbles represent the number of patients per country (range, 13 to 89). The horizontal lines represent the mean proportion of patients with no bDMARDs – DAPSA > 14 for each tertiles of countries by GDP/capita.

Conclusion:

In this exploratory comparison of disease patterns and treatments choices in 13 countries, we observed that more PsA patients with high or moderate disease activity and living in low GDP/capita countries were less likely to be treated with bDMARDs. As a consequence, no bDMARDs – DAPSA > 14 patients had worse functional incapacity. Equitable access to bDMARDs should be aimed for all patients regardless of their country of origin.

References:

[1]Gossec L et al. EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2019 update. Ann Rheum Dis. 2020 Jun;79(6):700-712.

[2]Gossec L et al. Are There Country Differences in Disease Activity and Life Impact of Psoriatic Arthritis? An Analysis of 436 Patients from 14 Countries [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10).

[3]Gorlier C et al. Comparing patient-perceived and physician-perceived remission and low disease activity in psoriatic arthritis: an analysis of 410 patients from 14 countries. Ann Rheum Dis. 2019 Feb;78(2):201-208.

Disclosure of Interests:

None declared.

Can renalase be a novel candidate biomarker for distinguishing renal tumors?

Renalase (RNLS) is synthesized mainly in renal tissues. The function of RNLS in cancerous renal tissues has not been investigated. We investigated the synthesis of RNLS in chromophobe renal cell carcinoma, papillary renal cell carcinoma and clear cell renal cell carcinoma with Fuhrman grades (FG): FG1, nucleoli are absent or inconspicuous and basophilic; FG2, nucleoli are conspicuous and eosinophilic and visible but not prominent; FG3, nucleoli are conspicuous and eosinophilic; FG4, extreme nuclear pleomorphism, multinucleate giant cells, and/or rhabdoid and/or sarcomatoid differentiation. We used 90 tissue samples including 15 healthy controls, 15 chromophobe renal cell carcinoma tissues and 10 papillary renal cell carcinoma renal tissues: 12 FG1, 14 FG 2, 14 FG 3 and 10 FG4. RNLS in the tissue samples was measured using enzyme linked immunosorbent assay and immunostaining of RNLS in these tissues. RNLS was significantly greater in the chromophobe renal cell carcinoma and papillary renal cell carcinoma tissues than the control. The least amount of RNLS was found in the renal tissues of clear cell renal cell carcinoma FG1; the amount of RNLS increased as the FG grades increased. Because RNLS increased significantly in renal tissues due to cancer, except for clear cell renal cell carcinoma FG1, RNLS may be useful biomarker for distinguishing grades of renal cancer. Because RNLS increases cell survival, anti-RNLS preparations may be useful for treating cancer in the future.

Effects of carnosine on apoptosis, transient receptor potential melastatin 2, and betatrophin in rats exposed to formaldehyde

We investigated the effects of exposure to formaldehyde on transient receptor potential melastatin 2, betatrophin, total oxidant status and total antioxidant status in rat liver and kidney tissues. We also investigated the effects of carnosine on formaldehyde treated animals. We used 28 male rats divided ramdomly into four groups of seven: untreated control group, carnosine treated group, formaldehyde treated group and formaldehyde + carnosine group. The experiment lasted for four weeks. Betatrophin levels in samples were measured uing the enzyme-linked immunosorbent assay, and total oxidant status and total antioxidant status were measured using REL assay diagnostic kits. We detected betatrophin and transient receptor potential melastatin 2 immunoreactivity using immunohistochemistry and assessed apoptosis using terminal deoxynucleotidyl transferase dUTP nick end labeling. The betatrophin and total antioxidant status levels decreased in kidney, liver and plasma following exposure to formaldehyde, while total oxidant status and terminal deoxynucleotidyl transferase dUTP nick end labeling positivity increased. Carnosine supplementation reversed histopathology and biochemical damage caused by formaldehyde. We suggest that carnosine treatment may be useful for protecting persons exposed to formaldehyde.

AB1039 LL-37, IL-36, GALECTIN-3 AND TLR-3 LEVELS IN IDIOPATHIC GRANULOMATOUS MASTITIS

Background:

Idiopathic granulomatous mastitis (IGM) is a non-infectious inflammatory disorder of the breast characterized by non-caseous granulomas. It is a chronic granulomatous inflammatory disease frequently seen in young fertile women, the cause of which has not been clearly understood. Immunosuppressive agents and surgical interventions are used in the treatment.

LL-37 is a cathelicidin-derived antimicrobial peptide with immunomodulatory properties that are effective in innate immunity. In addition, IL-36, galectin-3, TLR-3 are effective in autoimmunity with proinflammatory properties.

Objectives:

With this study, we aimed to investigate the potential alterations of LL-37, IL 36, Galectin 3 and TLR-3 levels in IGM.

Methods:

35 female patients with biopsy-confirmed IGM and 35 healthy controls were included in the study. The serum samples of the subjects LL-37, IL 36, Galectin 3 and TLR-3 levels were studied using the Elisa method. While studying LL 37 and Galectin 3 levels in the tissue, samples of 10 patients who underwent mammoplasty for cosmetic reasons were used for the control group. Ten patients whose paraffin blocks were eligible for re-study were included in the study for tissue examinations. Based on the prevalence (0.1: <%25,- 0.4:%26-50, 0.6:%51-75, 0.9:%76-100) and severity (0: no, +0.5: very little, +1: little, +2: medium, +3: severe) of immunoreactivity in staining, histoscore was created (histoscores = prevalence x severity).

The data were evaluated using appropriate statistical analysis and p <0.05 was considered statistically significant.

Results:

When the patient and control groups included in the study were compared, there was no significant difference in age. In serum samples, LL 37, IL 36, Galectin 3 and TLR 3 levels were statistically significantly lower in IGM group compared to the control group (p <0.001 for each) (Table-1). In biopsy samples, LL 37 level was found to be significantly lower in IGM group compared to the control group (p <0.001). However, no significant difference was detected in Galectin 3 levels in tissue studies (Table-2).

Conclusion:

In our study, we found that the levels of LL 37, IL 36, Galectin 3 and TLR 3 decreased in serum samples in IGM disease whose etiology was not clearly understood. In addition, we showed that in patients with IGM, LL 37 levels decreased at the tissue level. Studies have shown that in cases of severe sarcoidosis, LL 37 deficiency is reduced both in level and gene expression. So they thought, deficiency of cathelicidin LL 37 may impede resolution of inflammation in the tissue of patients with severe form disease.

References:

[1]Barna, Barbara P et al. “Alveolar macrophage cathelicidin deficiency in severe sarcoidosis.” Journal of innate immunity vol. 4,5-6 (2012): 569-78.

[2]Al-Khaffaf, Bilal et al. “Idiopathic granulomatous mastitis: a 25-year experience.” Journal of the American College of Surgeons vol. 206,2 (2008): 269-73.

Table 1.

LL 37, IL 36, Galectin 3 and TLR 3 levels in serum samples

IGM(N:35)CONTROL (N:35)PAge35,92 ± 5,1934,03 ± 3,810,08LL 37 (ng/ml)5,20 ± 5,4840,05 ± 31,97<0,001IL 36 (pg/ml)294,74 ± 125,94864,71 ± 442,39<0,001Galectin 3 (ng/ml)3,61 ± 3,1615,53 ± 10,14<0,001TLR 3 (pg/ml)931,49 ± 443,864019,36 ± 2599,51<0,001

IGM: Idiopathic granulomatous mastitis

Table 2.

Evaluation of LL-37 and Galectin 3 levels with histoscores in biopsy samples

IGM (N:10)CONTROL (N:10)PLL 370,006 ± 0,0250,140 ± 0,516<0,001Galectin 30,293 ± 0,2010,400 ± 0,2900,32

Disclosure of Interests:

None declared

SAT0378 THE RELATIVE DIAGNOSTIC UTILITY OF INFLAMMATORY BACK PAIN CRITERIA IN AN INCEPTION COHORT OF PATIENTS WITH PSORIASIS, IRITIS, AND COLITIS PRESENTING WITH UNDIAGNOSED BACK PAIN

Background:

Clinicians rely on the elicitation of features of inflammatory back pain (IBP) for diagnosis of axial spondyloarthritis (axSpA) but the utility of IBP criteria in patients presenting with extra-articular features of axSpA remains unclear. Assessment of utility should include not only rheumatologist diagnosis as benchmark but imaging to address the circularity between elicitation of IBP and clinical diagnosis.

Objectives:

To assess the diagnostic utility of all criteria for IBP in patients with psoriasis, iritis, or colitis and undiagnosed back pain using the rheumatologist diagnosis and imaging as benchmarks.

Methods:

Consecutive patients (n=246) with undiagnosed back pain ≤45 years of age, ≥3 months, with any one of psoriasis (n=46), acute anterior uveitis (AAU)(n=73), or colitis (n=127) had diagnostic evaluation by a rheumatologist. Majority central reader assessment of MRI indicative of axSpA and diagnosis by the rheumatologist were external standards for testing the utility of these IBP criteria: ASAS, Berlin, Calin, rheumatologist global for IBP >5 (0-10 scale).

Results:

AxSpA was diagnosed in 44.4%, 61.6%, and 41.8% of patients with psoriasis, iritis, and IBD, respectively. Diagnostic utility for all IBP criteria was comparably poor (Table 1). MRI was indicative of axSpA in 21.2%, 43.5%, and 19.7% of patients with psoriasis, iritis, and IBD. The utility of the IBP criteria was even worse using MRI as the external reference (Table 2), especially in patients with psoriasis. Only 14% of psoriasis patients with a positive MRI reported “improvement with exercise but not rest” as compared to 70% and 62% of patients with iritis and IBD, respectively.

Table 1.

Rheumatologist diagnosis as external reference.

SensitivitySpecificityLR+LR-PsoriasisASAS IBP65.00%52.00%1.350.67Berlin IBP80.00%36.00%1.250.56Calin IBP80.00%28.00%1.110.71All 3 criteria sets60.00%56.00%1.360.71IBP global >585.00%36.00%1.330.42AAUASAS IBP84.44%42.86%1.480.36Berlin IBP80.00%57.14%1.870.35Calin IBP93.33%17.86%1.140.37All 3 criteria sets77.78%60.71%1.980.37IBP global >586.67%57.14%2.020.23IBDASAS IBP78.43%45.07%1.430.48Berlin IBP82.35%52.11%1.720.34Calin IBP84.31%19.72%1.050.80All 3 criteria sets70.59%57.75%1.670.51IBP global >580.39%66.20%2.380.30Table 2.

Central assessment that MRI is indicative of axSpA as external reference.

SensitivitySpecificityLR+LR-PsoriasisASAS IBP28.57%38.46%0.461.86Berlin IBP42.86%15.38%0.513.71Calin IBP71.43%23.08%0.931.24All 3 criteria sets14.29%42.31%0.252.03IBP global >585.71%23.08%1.110.62AAUASAS IBP75.00%26.92%1.030.93Berlin IBP70.00%38.46%1.140.78Calin IBP90.00%15.38%1.060.65All 3 criteria sets65.00%38.46%1.060.91IBP global >575.00%38.46%1.220.65IBDASAS IBP92.31%37.74%1.480.20Berlin IBP76.92%39.62%1.270.58Calin IBP92.31%16.98%1.110.45All 3 criteria sets76.92%45.28%1.410.51IBP global >592.31%47.17%1.750.16

Conclusion:

All IBP criteria have poor diagnostic utility for diagnosis of axSpA, especially in patients with psoriasis. This reinforces the desirability of less subjective assessment tools, especially imaging.

Disclosure of Interests:

Georg Kröber: None declared, Ulrich Weber: None declared, Raj Carmona: None declared, James Yeung: None declared, Jon Chan: None declared, Sibel Aydin: None declared, Liam Martin: None declared, Ariel Masetto: None declared, Stephanie Keeling: None declared, Olga Ziouzina: None declared, Sherry Rohekar: None declared, Rana Dadashova: None declared, Joel Paschke: None declared, Amanda Carapellucci: None declared, Robert G Lambert: None declared, Walter P. Maksymowych Grant/research support from: AbbVie, Novartis, Pfizer, and UCB, Consultant of: AbbVie, Boehringer Ingelheim, Celgene, Eli Lilly, Galapagos, Janssen, Novartis, Pfizer, and UCB, Employee of: Chief Medical Officer of CARE Arthritis Limited, Speakers bureau: AbbVie, Janssen, Novartis, Pfizer, and UCB

SAT0383 ENHANCED PERFORMANCE OF THE ASAS CLASSIFICATION CRITERIA BY DELETION OF NON-DISCRIMINATORY CLINICAL ITEMS: DATA FROM THE SCREENING IN AXIAL SPONDYLOARTHRITIS IN PSORIASIS, IRITIS, AND COLITIS COHORT

Background:

The ASAS classification criteria for axial spondyloarthritis (axSpA) have overall sensitivity/specificity of 82.9%/84.4% but component imaging and clinical arms differ in performance (66.2%/97.3% and 56.6%/83.3%, respectively)1.

Objectives:

We aimed to demonstrate that a data-driven elimination of SpA clinical features that were non-discriminatory in comparisons of patients diagnosed with and without axSpA in a prospective cohort of patients with undiagnosed back pain could enhance the performance of the criteria.

Methods:

We used data from the prospective multicenter Screening for Axial Spondyloarthritis in Psoriasis, Iritis, and Colitis (SASPIC) Study. Consecutive patients ≤45 years of age with ≥3 months undiagnosed back pain with any one of psoriasis, AAU, or colitis undergo routine diagnostic evaluation by a rheumatologist for axial SpA, including imaging assessed by central readers. Univariable and multivariable logistic regression analysis was performed to determine which clinical SpA features were/were not discriminatory for the final diagnosis of axSpA. We then compared the sensitivity and specificity of the ASAS criteria with and without these features.

Results:

A total of 246 patients were recruited, 47.6% being diagnosed with axSpA (61.5% male, age 33.7 years, symptom duration 7.6 years, B27 positive 52.1%). The following clinical SpA features were non-discriminatory between axSpA/not axSpA: NSAID response, family history of SpA, heel enthesitis, peripheral arthritis, dactylitis. Specificity of the clinical arm and the overall criteria increased from 82.2% to 86.8% without impacting sensitivity. This effect was particularly noteworthy in patients with lower degree of symptomatology (back pain severity <5/10, specificity increases from 76.7% to 90.7%), short symptom duration (<5 years, specificity increases from 78% to 84.7%), and in females (specificity increases from 80.6% to 86.1%).

Conclusion:

In a prospective cohort with a high pre-test probability of axSpA certain clinical SpA features were not helpful in discriminating a diagnosis of SpA from not-SpA. Deletion of these features from the list of SpA features used in the ASAS classification criteria enhanced the performance of the criteria, especially in female patients and those with early disease.

References:

[1]Rudwaleit et al. Ann Rheum Dis 2009;68: 777-83

Patient CategoryNumberASAS criteriaImaging armClinical armSenSpecSenSpecSensSpecAll patients2466582.236.897.750.482.2High confidence in diagnosis19073.884.547.598.256.384.5Patients with back pain ≥5/1016563.384.934.298.851.984.9Patients with back pain <58168.476.742.195.347.476.7Patients with symptom duration ≥5 years10371.285.735.697.156.285.7Patients with symptom duration <5 years14354.57838.698.340.978Males12968.184.247.298.248.684.2Females1176080.62097.253.380.6After deletion of ‘NSAID response’, ‘Family Hx SpA’, ‘heel enthesitis’, ‘peripheral arthritis’, ‘dactylitis’ SpA featuresAll patients2466586.836.897.750.486.8High confidence in diagnosis19073.887.347.598.256.387.3Patients with back pain ≥5/1016563.384.934.298.851.984.9Patients with back pain <58168.490.742.195.347.490.7Patients with symptom duration ≥5 years10371.288.635.697.156.288.6Patients with symptom duration <5 years14354.584.738.698.340.984.7Males12968.187.747.298.248.687.7Females1176086.12097.253.386.1

Disclosure of Interests:

Walter P. Maksymowych Grant/research support from: AbbVie, Novartis, Pfizer, and UCB, Consultant of: AbbVie, Boehringer Ingelheim, Celgene, Eli Lilly, Galapagos, Janssen, Novartis, Pfizer, and UCB, Employee of: Chief Medical Officer of CARE Arthritis Limited, Speakers bureau: AbbVie, Janssen, Novartis, Pfizer, and UCB, Raj Carmona: None declared, Jon Chan: None declared, James Yeung: None declared, Sibel Aydin: None declared, Liam Martin: None declared, Ariel Masetto: None declared, Olga Ziouzina: None declared, Stephanie Keeling: None declared, Sherry Rohekar: None declared, Rana Dadashova: None declared, Joel Paschke: None declared, Amanda Carapellucci: None declared, Robert G Lambert: None declared

FRI0298 ASAS MODIFICATION OF THE BERLIN ALGORITHM AND THE DUET ALGORITHM FOR DIAGNOSING AXIAL SPONDYLOARTHRITIS: RESULTS FROM THE SCREENING IN AXIAL SPONDYLOARTHRITIS FOR PSORIASIS, IRITIS, AND COLITIS COHORT

Background:

Patients presenting with back pain and psoriasis, iritis, or colitis, represent a high-risk population for the presence of axial spondyloarthritis (axSpA). The Dublin Evaluation Tool (DUET)1, the Berlin algorithm2, and the ASAS modification of this algorithm3are recommended referral strategies aimed at early diagnosis of axSpA. DUET was developed for patients presenting with AAU. Validation of these algorithms in inception cohorts is limited.

Objectives:

1. To assess the performance of referral algorithms for diagnosis of axSpA when tested against the final local rheumatologist diagnosis in an inception cohort of patients presenting with undiagnosed back pain and extra-articular manifestations. 2. To determine whether different criteria for inflammatory back pain (IBP) impact the performance of the algorithms.

Methods:

The multicenter Screening for Axial Spondyloarthritis in Psoriasis, Iritis, and Colitis (SASPIC) Study at 11 sites is aimed at early detection of axial SpA in patients presenting with undiagnosed back pain to the rheumatologist. Consecutive patients ≤45 years of age with ≥3 months undiagnosed back pain with any one of psoriasis, acute anterior uveitis (AAU), or colitis diagnosed by the relevant specialist undergo routine clinical evaluation by a rheumatologist for axial SpA. The rheumatologist determines the presence or absence of axial SpA at 3 consecutive stages: 1. After the clinical evaluation; 2. After the results of labs (B27, CRP) and radiography; 3. After the results of MRI evaluation. Final diagnosis by the rheumatologist was used as external standard to test the performance of the algorithms. We tested the following criteria for IBP in the algorithm: ASAS, Berlin, rheumatologist global for likelihood of IBP >5 (0-10 scale), and DUET algorithm in AAU patients.

Results:

A total of 246 patients were recruited, 73 presented with iritis, 46 with psoriasis, and 127 with colitis, 47.6% were diagnosed with axSpA. The diagnosis of axSpA was established in 45.7%, 61.6%, and 40.2% of patients with psoriasis, AAU, and IBD, respectively. The performance of the ASAS-modification of the Berlin algorithm was superior to the original algorithm as reported previously3, primarily for enhanced sensitivity, and this was observed irrespective of the criteria used to define IBP (Table 1). Conversely, the performance of the Duet algorithm in the subset of patients with AAU was substantially worse than previously reported1.

Conclusion:

The ASAS modification of the Berlin algorithm is the preferred referral strategy for patients presenting with undiagnosed back pain to the rheumatologist.

References:

[1]Haroon M, et al. Ann Rheum Dis 2015; 74: 1990-5

[2]Poddubnyy D, et al. J Rheumatol 2011; 38: 2452–60

[3]Van den Berg R, et al. Ann Rheum Dis 2013;72:1646–53

AlgorithmSensitivity (%)Specificity (%)Correct diagnosis (%)False negative (%)False positive (%)Original Berlin(ASAS criteria for IBP)65.376.671.116.712.2Original Berlin(Berlin criteria for IBP)64.476.670.717.112.2Original Berlin(IBP global >5)67.878.173.215.411.4ASAS Modification of Berlin algorithm (ASAS criteria for IBP)73.775.874.812.612.6ASAS Modification of Berlin algorithm (Berlin criteria for IBP)73.775.074.412.613.0ASAS Modification of Berlin algorithm(IBP global >5)76.377.376.811.411.8DUET84.450.071.29.619.2

Disclosure of Interests:

Ulrich Weber: None declared, Georg Kröber: None declared, Raj Carmona: None declared, James Yeung: None declared, Jon Chan: None declared, Sibel Aydin: None declared, Liam Martin: None declared, Ariel Masetto: None declared, Stephanie Keeling: None declared, Olga Ziouzina: None declared, Sherry Rohekar: None declared, Rana Dadashova: None declared, Amanda Carapellucci: None declared, Joel Paschke: None declared, Robert G Lambert: None declared, Walter P. Maksymowych Grant/research support from: AbbVie, Novartis, Pfizer, and UCB, Consultant of: AbbVie, Boehringer Ingelheim, Celgene, Eli Lilly, Galapagos, Janssen, Novartis, Pfizer, and UCB, Employee of: Chief Medical Officer of CARE Arthritis Limited, Speakers bureau: AbbVie, Janssen, Novartis, Pfizer, and UCB

THU0248 GLOMERULAR AND TUBULOINTERSTITIAL LESIONS IN PER-PROTOCOL REPEAT BUT NOT BASELINE KIDNEY BIOPSY PORTEND RELAPSE AND LONG-TERM RENAL FUNCTION IMPAIRMENT, RESPECTIVELY, IN INCIDENT CASES OF PROLIFERATIVE LUPUS NEPHRITIS

Background:

In patients with lupus nephritis (LN), clinical response to treatment and renal histopathology have been shown to be discordant. No clinical or laboratory markers have to date been shown to reliably portend renal prognosis, in particular renal function impairment.

Objectives:

To investigate whether per-protocol repeat renal biopsies are predictive of LN relapses and long-term impairment of renal function.

Methods:

Forty-two patients with an incident biopsy-proven active proliferative (class III/IV ± V) LN from the LN database of the Université catholique de Louvain were included in the present retrospective study. Per-protocol repeat kidney biopsies were performed in all patients after a median time of 24.3 (IQR: 21.3–26.2) months. The NIH activity index (AI) and chronicity index (CI) scores were assessed in both baseline and repeat biopsies. We defined acute glomerular lesions as cellular proliferation, fibrinoid necrosis or karyorrhexis, cellular crescents, hyaline thrombi or wire loops, and leucocyte infiltration, and chronic glomerular lesions as glomerular sclerosis and fibrous crescents, in alignment with the NIH activity and chronicity indices. Similarly, we defined acute tubulointerstitial lesions as mononuclear cell infiltration and chronic tubulointerstitial lesions as interstitial fibrosis and tubular atrophy.

Results:

Despite a moderate correlation between urinary protein/creatinine (U-P/C) ratios and AI scores at repeat biopsy (r=0.48; P=0.001), ten patients (23.8%) with U-P/C ratios <1.0 g/g still had a high degree of histological activity (AI score >3). High AI scores in repeat (but not baseline) kidney biopsies were associated with an increased probability and/or shorter time to renal relapse (N=11) following the repeat biopsy (HR: 1.2; 95% CI: 1.1–1.3; P=0.007), independently of proteinuria levels. This association remained significant for the NIH activity index items within the glomerular but not the tubulointerstitial compartment of the kidney biopsies. High NIH CI scores in repeat (but not baseline) kidney biopsies were associated with a sustained increase in serum creatinine levels corresponding to ≥120% of the baseline value (HR: 1.8; 95% CI: 1.1–2.9; P=0.016) through a median follow-up time of 131.5 (IQR: 73.8–178.2) months, being the case also for acute and chronic tubulointerstitial lesions in repeat but not baseline kidney biopsies.

Conclusion:

Our results highlight the usefulness of per-protocol repeat biopsies as an integral part of the treatment evaluation, also in patients who have shown adequate clinical response. Glomerular lesions consistent with active renal disease portend LN relapses, while tubulointerstitial lesions consistent with active disease and chronic damage portent long-term renal function impairment.

Disclosure of Interests:

Ioannis Parodis: None declared, Christina Adamichou: None declared, Selda Aydin: None declared, Alvaro Gomez: None declared, Nathalie Demoulin: None declared, Julia Weinmann-Menke: None declared, Frederic Houssiau Grant/research support from: UCB, Consultant of: GSK, Farah Tamirou: None declared

AB0743 DISEASE CHARACTERISTICS OF PSORIATIC ARTHRITIS PATIENTS MAY DIFFER ACCORDING TO AGE AT PSORIASIS ONSET: CROSS-SECTIONAL ANALYSIS OF PSORIATIC ARTHRITIS-INTERNATIONAL DATABASE

Background:

Psoriasis and psoriatic arthritis (PsA) are heterogenous diseases with various disease manifestations and phenotypes. Psoriasis has a bimodal age of onset being early (before the age of 40, type 1) and late. The impact of this classification on the PsA features is not well understood.

Objectives:

To compare the PsA characteristics of patients with early- and late-onset psoriasis in a large, multicenter database

Methods:

PSART-ID (Psoriatic Arthritis-International Database) is a prospective, multicenter web-based registry (www.trials-network.org) of patients with PsA. A detailed data collection was performed including demographics (sex, age, duration of education, smoking status, BMI), skin features (psoriasis onset date, type, initially involved site of skin, nail involvement (ever) and family history) and PsA characteristics (type of articular involvement and presence of axial, dactylitis (ever), enthesitis (ever), family history) and indices for disease activity and function (DAPSA, Leeds enthesitis index, BASDAI, BASFI, patient and physician global assessment, pain, HAQ-DI). We grouped according to the age at psoriasis onset (early onset, psoriasis before the age of 40 (EOPsO); late-onset, psoriasis after the age of 40 (LOPsO)), patient and disease characteristics of the groups were compared (1). Due to the differences among groups, following adjustments weer made: BMI for age, nail involvement for PsO disease duration, axial PsA for PsA disease duration.

Results:

A total of 1634 (62.8% females; EOPsO, 1108 (67.8%); LOPsO, 526 (32.2%)) patients with PsA was recruited. Rate of over-weight patients was higher in LOPsO group (66.8% vs. 86.8%, p<0.001; adjusted for age - aOR 1.55 (1.11-2.20; % 95 CI)). The EOPsO group had the scalp involvement as the initial site of skin disease more often than the LOPsO group (56.7% vs. 43.0%, p<0.001), whereas extremity involvement was more frequent as the initial finding in the LOPsO group (EOPsO vs. LOPsO 63.8% vs. 74.2%, p<0.001). Nail involvement (ever) was more prominent in EOPsO group, however, the significance was disappeared when adjusted for psoriasis duration. Interaction between gender and both axial disease and psoriatic disease family history were found (axial disease in man; EOPsO vs LOPsO; 38.0% vs. 25.4%; p=0.005; adjusted for PsA duration - aOR 0.56 (0.38-0.84; %95 CI) // psoriatic disease family history in females; EOPsO vs LOPsO; 39.5% vs. 30.1%; p=0.003; OR 0.65 (0.50-0.86; %95 CI)). Duration between PsO and PsA was significantly longer in EOPsO group (148 vs. 24 months, p<0.001). In EOPsO group, more patients had PsO preceeding PsA than LOPsO group (81.8% vs. 60.6%, p<0.001), however, synchronous disease -defined as the diagnosis of PsO and PsA within the same year- was more common in LOPsO group (16.6% vs. 30.3%, p<0.001) (Table 1). Psoriatic disease activity parameters, patient and physician reported outcomes and HAQ-DI scores were similar in both groups.

Table 1.

Comparison of psoriatic arthritis patients‘ characteristics according to age at psoriasis onset

Conclusion:

Clinical features of PsA may be affected by the age at the onset of psoriasis. As the genetic background is different in early and late-onset psoriasis, this may suggest a different pathogenetic mechanism based on the psoriasis phenotype, also affecting the PsA features. Further prospective studies are needed to define whether the classification of PsA requires including psoriasis phenotypes as well.

References:

[1]Henseler T, Christophers E. Psoriasis of early and late onset: characterization of two types of psoriasis vulgaris. J Am Acad Dermatol. 1985;13(3):450-6.

Disclosure of Interests:

Emre Bilgin: None declared, Özün Bayindir: None declared, esen kasapoğlu: None declared, Sibel Bakirci: None declared, Dilek Solmaz: None declared, Gezmiş Kimyon: None declared, Atalay Doğru: None declared, Ediz Dalkiliç: None declared, Cem Özişler: None declared, Meryem Can: None declared, Servet Akar: None declared, Emine Figen Tarhan: None declared, Şule Yavuz: None declared, Levent Kiliç: None declared, Orhan Küçükşahin: None declared, Ahmet Omma: None declared, Emel Gönüllü: None declared, Fatih Yildiz: None declared, Duygu Ersözlü: None declared, abdurrahman tufan: None declared, Muhammet Çinar: None declared, Abdulsamet Erden: None declared, Sema Yilmaz: None declared, Seval Pehlevan: None declared, Tuncay Duruöz: None declared, Sibel Aydin: None declared, Umut Kalyoncu Consultant of: Abbvie, Amgen, Janssen, Lilly, Novartis, UCB

AB0761 DEMOGRAPHIC AND CLINICAL FEATURES OF JUVENILE-ONSET PSORIATIC ARTHRITIS: RESULTS FROM PsART-ID REGISTRY

Background:

Although psoriatic arthritis (PsA) may be seen at any decades, juvenil onset PsA is relatively rare. Moreover, there were no more data about clinical features, treatments, and course in juvenile PsA when they reached to adult age.

Objectives:

The objective of this study was to assess and compare demographic and clinical features for juvenile onset PsA and adult onset PsA.

Methods:

PsART-ID is a multicenter, international database, investigating the disease characteristic in real life (1). Briefly, demographic data, PsA subtypes, uveitis, enthesitis, dactylitis, Co-morbidities, disease activity scores (TJC, SJC, VAS-pain, VAS patients and physician global assessments, VAS-fatigue, BASDAI), and functional status (HAQ-DI, BASFI) were recorded. Psoriasis and PsA starting age were noted, as well. Patients were classified as juvenile PsA or juvenile PsO (under 18 years old). Results were compared regarding to juvenile versus adult onset age.

Results:

Overall, 1644 PsA patients were included to study, 301/1644 (18.3%) patients had juvenile onset psoriasis. Of 39/1644 (2.4%) patients had juvenile onset PsA, as well. As expected, juvenile onset PsA patients were younger, however PsA disease duration were longer than adult onset PsA patients. There were no any difference between demographic and clinical data, except BMI and enthesitis were less frequently at the juvenile onset PsA groups. Although, ever csDMARD using were similar between two groups, however, juvenile onset PsA patients were used more frequently bDMARDs.

Table.

Comparison of demographic and clinical characteristics of juvenile and adult-onset psoriatic arthritis

Juvenile onsetAdult onsetpN (%)39 (2.4)1605 (97.6)Female Sex n (%)24 (61.5)1006 (62.7)0.884PsA beginning age mean (SD)13.3 ± 3.8542.3 ± 12.9<0.001Current age mean (SD)26.6 ±10.747.3 ±13.07<0.001Duration of psoriasis (years)17.10 ± 11.2614.75 ± 11.780.124Duration of psoriatic arthritis (years)13.5 ±115.06 ± 6.7<0.001Cigarette smoking (ever) n (%)15/38641/14940.72Education duration/year (mean,SD)10.09 ± 3.679.52 ± 4.810.464BMI (kg/m2) (mean, SD)24.5 ±5.128.3 ± 5.21<0.001Family history of PsO/PsA n (%)15 (38.5)559 (34.9)0.642Nail involvement n (%)18 (46.2)762 (47.5)0.864Dactilitis n (%)9 (23.7)367 (24)0.958Entesitis n (%)3 (7.9)384 (25.7)0.013Uveitis n (%)-13 (4.3)0.713Axial involvement (%)15 (38.5)464 (29)0.199Methotrexate36 (92.3)1348 (84)0.162Sulfasalazine17 (43.6)612 (38.1)0.488Leflunomide14 (35.9)379 (23.6)0.076Biologic DMARDs102 (33.9)358 (26.8)0.013

Conclusion:

Although psoriasis may be seen frequently in the juvenile age, juvenile onset PsA was not so frequent in our PsA cohort. Although, ever csDMARD using were similar between two groups, however, juvenile onset PsA patients were used bDMARDs more frequently.

References:

[1]Kalyoncu U et al. The Psoriatic Arthritis Registry of Turkey: results of a multicenter registry on 1081 patients. Rheumatology. 2017;56:279-286.

Disclosure of Interests:

Serpil ERGULU EŞMEN: None declared, Ozun Bayindir: None declared, esen kasapoğlu: None declared, Sibel Bakirci: None declared, Dilek Solmaz: None declared, Gezmiş Kimyon: None declared, Atalay Doğru: None declared, Ediz Dalkiliç: None declared, Cem Özişler: None declared, Meryem Can: None declared, Servet Akar: None declared, Emine Figen Tarhan: None declared, Sule Yavuz: None declared, Levent Kiliç: None declared, Orhan Küçükşahin: None declared, Ahmet Omma: None declared, Emel Gönüllü: None declared, Fatih Yildiz: None declared, Duygu Ersözlü: None declared, abdurrahman tufan: None declared, Muhammet Çinar: None declared, Abdulsamet Erden: None declared, Sema Yilmaz: None declared, Seval Pehlevan: None declared, Mehmet Tuncay Duruöz: None declared, Sibel Aydin: None declared, Umut Kalyoncu Consultant of: Abbvie, Amgen, Janssen, Lilly, Novartis, UCB

SAT0440 METHOTREXATE SURVIVAL RATE IN PATIENTS WITH PSORIATIC ARTHRITIS FROM PSORIATIC ARTHRITIS –INTERNATIONAL DATABASE (PsArt-ID) COHORT

Background:

Methotrexate (MTX) is the most common first-line disease-modified anti-rheumatic drugs in psoriatic arthritis (PsA), despite the controversies.

Objectives:

In this study, we aimed to determine the rate of withdrawal rate of MTX in PsA and reasons for discontinuing.

Objectives:

In this study, we aimed to determine the rate of withdrawal rate of MTX in PsA and reasons for discontinuing.

Methods:

A large prospective international multicenter PsA registry was used for this study. Data were collected either at enrolment, based on history, or prospectively if there was a follow up. We analyzed the frequency of MTX usage, discontinuation and the reason for discontinuation. The time on MTX was compared according to the reason of discontinuation (inefficacy vs side effects) using Kaplan-Meier and Cox regression analyses to identify risk factors for discontinuation.

Results:

At the time of analyses, 1670 patients had been recruited to the registry and 1359 PsA patients had used MTX during the course of the disease (81.3%). Within these, 942 (69.3%) were still on MTX at the time of analysis, and 417 (30.7%) patients have discontinued (Table). The most common reasons for withdrawal were side effects (219/417, 52.5%) and ineffectiveness (88/417, 21.1%). Other reasons included pregnancy, remission, self-decision (11.9% for all). For 60 patients (14.3%), the reason could not be identified. In patients who were still on MTX, the median duration of MTX therapy was 31 months (IQR=59) compared to 17 months (IQR=43) in the withdrawal group. The most common side effects were gastrointestinal symptoms (47%) and abnormal liver function tests (25%). There was a significant difference in survival plots (Log-rank p=0.026) with discontinuing due to side effects occurring earlier than inefficacy (Figure 1). In cox regression model, longer disease duration was found as an independent predictor of MTX discontinuation due to all reasons [Hazard Ratio (HR)=1.01, 95% Confidence interval (CI)=1.0-1.02; p=0.003].

Conclusion:

MTX is frequently used on PsA treatment, despite the controversies in the literature. One third of patients with PsA discontinue MTX, most commonly due to side effects or inefficacy. Patients discontinue MTX earlier in case of having side effects. Longer disease duration is linked to MTX discontinuation.

Table.

Demographics and disease characteristics of study groups

All patientsn=1359Still on MTXn=942Withdrawal MTX any reasonn=417pAge, mean (SD)46.4 (13.4)46.1 (13.4)47.7 (14.0)0.038Male gender, n (%)523 (38.5)360 (38.2)163 (39.1)0.761Ever smoking, n (%)569/1258 (46.2)390/861 (45.3)179/397 (45.1)0.966Psoriasis duration (years), mean (SD)14.2 (11.7)14.0 (11.2)16.4 (12.7)0.003Polyarthritis, n (%)657/1343 (48.9)471/931 (50.6)186/412 (45.1)0.066Axial disease, n (%)388/1343 (28.9)267/931 (28.7)121/412 (29.4)0.797Nail involvement (ever), n (%)644 (47.8)435 (46.6)209 (50.5)0.191Swollen Joint Count, mean (SD)1.5 (2.6)1.4 (2.6)2.0 (3.2)<0.001Tender Joint Count, mean (SD)3.0 (4.4)3.5 (5.0)4.2 (5.4)<0.001HAQ, mean (SD)0.6 (0.6)0.7 (0.7)0.8 (0.7)0.035BASDAI,mean (SD)37 (22)39 (23)46 (25)0.001

Disclosure of Interests:

Dilek Solmaz: None declared, Umut Kalyoncu Consultant of: Abbvie, Amgen, Janssen, Lilly, Novartis, UCB, Ilaria Tinazzi: None declared, Ozun Bayindir: None declared, Ediz Dalkiliç: None declared, Atalay Dogru: None declared, Cem Özişler: None declared, Gezmiş Kimyon: None declared, Gozde Yildirim Cetin Speakers bureau: AbbVie, Novartis, Pfizer, Roche, UCB, MSD, Ahmet Omma: None declared, Emine Figen Tarhan: None declared, Levent Kiliç: None declared, Servet Akar: None declared, Sema Yilmaz: None declared, Meryem Can: None declared, Sule Yavuz: None declared, Orhan Küçükşahin: None declared, Sibel Bakirci: None declared, Sibel Aydin: None declared

An In Vitro Study on the Interactions of Pycnogenol® with Cisplatin in Human Cervical Cancer Cells

Objectives

In the treatment of cancer, it is intended to increase the anticancer effect and decrease cytotoxicity using various plant-derived phenolic compounds with chemotherapeutic drugs. Pycnogenol^® (PYC), a phenolic compound, has been the subject of many studies. Since the mechanisms of the interactions of PYC with cisplatin need to be clarified, we aimed to determine the effects of PYC on cisplatin cytotoxicity in human cervix cancer cells (HeLa) and to evaluate the genotoxicity of PYC.

Materials and Methods

The cytotoxicity of cisplatin and PYC was measured by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay in HeLa cells for 24 h and 48 h. The effect of PYC against oxidative DNA damage was evaluated using the comet assay.

Results

The IC₅₀ values of cisplatin were 22.4 μM and 12.3 μM for 24 h and 48 h, respectively. The IC₅₀ values of PYC were 261 μM and 213 μM for 24 h and 48 h, respectively. For 24 h exposure, PYC significantly reduced the IC₅₀ value of cisplatin at the selected concentrations (15.6-500 μM). For 48 h exposure, PYC did not change the cytotoxicity of cisplatin at concentrations between 15.6 and 125 μM, but significantly reduced it at concentrations of 250 μM and 500 μM. PYC alone did not induce DNA damage at concentrations of 10 μM or 25 μM; however, it significantly induced DNA damage at higher concentrations (50-100 μM). It also significantly reduced H₂O₂-induced DNA damage at all concentrations studied (10-100 μM).

Conclusion

Our results suggest that PYC may increase the cisplatin cytotoxicity in HeLa cells at nongenotoxic doses. The results might contribute to the anticancer effect of cisplatin with PYC in cervical carcinoma, but in order to confirm this result further in vitro studies with cancer cell lines and in vivo studies are needed.

The effects and mechanisms of the action of galangin on spatial memory in rats

BACKGROUND

Galangin, a flavonoid compound with acetylcholinesterase inhibitory activity, may improve cognitive functions by enhancing cholinergic transmission.

OBJECTIVES

We aimed to investigate the effects of galangin on spatial memory impairment in rats.

METHODS

The effects of galangin (50 and 100 mg/kg) and reference anti-dementia drug donepezil (1mg/kg) administrations were examined on memory impairment induced by the muscarinic cholinergic receptor antagonist scopolamine or the nicotinic cholinergic receptor antagonist mecamylamine in the Morris water maze (MWM) test. Hippocampal acetylcholine concentrations were also determined.

RESULTS

Galangin 50 and 100 mg/kg significantly decreased the mean distance to platform and increased the time spent in the escape platform quadrant in scopolamine-treated rats. Galangin 100 mg/kg significantly decreased the mean distance to platform and increased the time spent in the escape platform quadrant in mecamylamine-treated rats. The effects of galangin in the MWM were comparable with donepezil. Scopolamine and mecamylamine decreased acetylcholine concentrations, whereas galangin both alone and with mecamylamine or scopolamine administration increased acetylcholine concentrations.

CONCLUSION

Galangin improved memory impairment comparable to donepezil and nicotinic and muscarinic receptors may be involved in this effect. Galangin may be considered as a promising flavonoid in the prevention and treatment of memory impairment in Alzheimer's disease and other dementias (Fig. 7,Ref. 37).

Salivary gland anlage tumour of the nasopharynx: A case report and review for histopathological characteristics

INTRODUCTION

Congenital salivary gland anlage tumour of the nasopharynx is a lesion which usually presents with nasal and upper respiratory tract obstruction in the neonatal period. Timely diagnosis is essential to prevent the occurrence of respiratory complications in later childhood.

CASE REPORT

We present a 8-year-old boy complaining from difficulty in breathing and breastfeeding in the neonatal period due to an adenoid-like nasopharyngeal mass. Histological examination revealed solid and cystic squamous nests and numerous duct-like structures within collagenised stroma. Both epithelial and myoepithelial differentiation were noted in the tubular component.

DISCUSSION

A review of the clinical and histopathological features of published cases revealed that ancient lesions showed more prominent and complex epithelial component and more collagen rich stroma. We would like to suggest the possibility of salivary gland anlage tumour to be considered in the differential diagnosis of neonatal respiratory distress cases.

Effects of iloprost and sildenafil treatment on elabela, apelin-13, nitric oxide, and total antioxidant and total oxidant status in experimental enzyme-positive acute coronary syndrome in rats

Despite significant advances in medicine, mortality due to cardiovascular disease is not yet preventable. We investigated the amounts of elabela (ELA) and apelin, synthesized by cardiomyocytes, and changes of these compounds in cardiac tissue and circulation after administration of iloprost (ILO) and sildenafil (SIL) in rats with induced myocardial ischemia (MI). We also investigated a connection with circulating troponin-I, creatine kinase (CK), creatine kinase-myocardial band (CK-MB) and nitric oxide (NO), and total anti-oxidant (TAS)/total oxidant status (TOS). We established eight study groups of five rats each. Group 1, sham, was given only physiologic serum; group 2, ILO; group 3, SIL; group 4, ILO + SIL; group 5, MI; group 6, MI + ILO; group 7, MI + SIL; group 8, MI + ILO + SIL. Troponin-I, CK, CK-MB and TAS-TOS were investigated using an autoanalyzer. NO, ELA and apelin were analyzed by ELISA. Tissue apelin and ELA expressions and localizations were determined by immunohistochemistry. The MI group compared to the control (sham) group showed that ELA, apelin, troponin-I, CK, CK-MB, NO and TOS levels were elevated significantly. Concentrations of these factors increased in MI, but decreased after ILO and SIL administration. The largest decrease of TOS was identified in the ILO + SIL group. ELA and apelin may be novel indicators of MI and administration of ILO and SIL, individually or together, may be useful for treating MI.

An In Vitro Study on the Cytotoxicity and Genotoxicity of Silver Sulfide Quantum Dots Coated with Meso-2,3-dimercaptosuccinic Acid

Objectives

Silver sulfide (Ag₂S) quantum dots (QDs) are highly promising nanomaterials in bioimaging systems due to their high activities for both imaging and drug/gene delivery. There is insufficient research on the toxicity of Ag₂S QDs coated with meso-2,3-dimercaptosuccinic acid (DMSA). In this study, we aimed to determine the cytotoxicity of Ag₂S QDs coated with DMSA in Chinese hamster lung fibroblast (V79) cells over a wide range of concentrations (5-2000 μg/mL).

Materials and Methods

Cell viability was determined by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) and neutral red uptake (NRU) assays. The genotoxic and apoptotic effects of DMSA/Ag₂S QDs were also assessed by comet assay and real-time polymerase chain reaction technique, respectively.

Results

Cell viability was 54.0±4.8% and 65.7±4.1% at the highest dose (2000 μg/mL) of Ag₂S QDs using the MTT and NRU assays, respectively. Although cell viability decreased above 400 μg/mL (MTT assay) and 800 μg/mL (NRU assay), DNA damage was not induced by DMSA/Ag₂S QDs at the studied concentrations. The mRNA expression levels of p53, caspase-3, caspase-9, Bax, Bcl-2, and survivin genes were altered in the cells exposed to 500 and 1000 μg/mL DMSA/Ag₂S QDs.

Conclusion

The cytotoxic effects of DMSA/Ag₂S QDs may occur at high doses through the apoptotic pathways. However, DMSA/Ag₂S QDs appear to be biocompatible at low doses, making them well suited for cell labeling applications.

A promising biomarker to distinguish benign and malignant renal tumors: ELABELA

Aim

The aim of this study was to investigate ELABELA (ELA) expression in benign and malignant renal tissues and expression differences in different nuclear grades of clear cell carcinomas.

Materials and Methods

Patients that underwent surgery due to renal masses between the years of 2007 and 2017 were used. Control renal tissues (n = 23), papillary RCC (n = 23), clear cell RCC (CcRCC) [Fuhrman Grade1 (n = 23), Fuhrman Grade2 (n = 23), Fuhrman Grade3 (n = 23), Fuhrman Grade4 (n = 23)], and chromophobe RCC (n = 23) were included to the study. The Independent samples t-test was used for 2-point intergroup assessments and the one-way analysis of variance and posthoctukey test was used for the others. Values of P < 0.05 were considered statistically significant.

Results

ELA immunoreactivity was observed in proximal and distal tubules in the kidney, but not in glomeruli in control tissues. When compared with control kidney tissue, a statistically significant increase was observed in ELA immunoreactivity in renal oncocytoma. In the chromophobe RCC, ELA immunoreactivity was significantly lower than control kidney tissue, whereas papillary RCC did not show ELA immunoreactivity. However, compared with control kidney tissue, ELA immunoreactivity was not observed in Fuhrman Grade 1 and Grade 2 CcRCC. Also, there was a significant decrease at Fuhrman Grade 3 and Grade 4 CcRCC compared with control kidney tissues. In the statistical analysis of ELA immunoreactivity among the Fuhrman nuclear grades of CcRCCs, The ELA immunoreactivity was higher at Grade 4 CcRCC than Grade 1, Grade 2, and Grade 3.

Conclusion

ELA is a usefull molecule to differentiate benign and malign renal tumors. But further broad and comprehensive studies are needed to investigate cellular and molecular mechanisms of ELAs on malign transformation.

Immunostaining characteristics of irisin in benign and malignant renal cancers

We investigated the expression of irisin in renal cancers using immunocytochemistry. Irisin has been reported to exhibit anticancer properties. The study groups consisted of 22 cases each of control renal tissue, oncocytoma, chromophobe renal cell carcinoma (RCC), clear cell RCC (Fuhrman nuclear grades 1, 2, 3 and 4) and papillary RCC. We evaluated 10 slides for each of 176 cases. Slides were immunostained for irisin and histoscores were calculated for the prevalence and strength of immunostaining. Fuhrman nuclear grade 1, 2, 3 clear cell RCC and papillary RCC exhibited no irisin immunoreactivity. Irisin immunoreactivity was observed in some Fuhrman nuclear grade 4 RCCs. We found a significant decrease in irisin staining in chromophobe RCC compared to the control. Immunoreactivity in the oncocytoma tissue was comparable to the control group. Irisin immunoreactivity in chromophobe RCC decreased and no immunoreactivity was observed in Fuhrman nuclear grade 1, 2, 3 clear cell RCC and papillary RCC. Immunistochemical screening of irisin in renal oncocytomas and renal cancers may be useful for differential diagnosis.

Caloric restriction improves the redox homeostasis in the aging male rat heart even when started in middle-adulthood and when the body weight is stable

Evidence indicates that maintenance of redox homeostasis is fundamental for cellular longevity. Caloric-restriction (CR) is said to decrease the formation of oxidatively modified cellular macromolecules and improve health. On the other hand, some studies indicate that many CR studies are flawed, because ad libitum fed rats are not well-controlled. Thus, it is claimed that purported beneficial effects of CR could be not due to real CR effect, but due to control animals going obese. Also, it remains to be elucidated whether effects of CR could be observed even when CR is started in mid-adulthood. Male Sprague-Dawley rats were grouped as: non-CR 6-month-old rats (n = 7), 24-month-old rats subjected to 40% CR for 6 months between 18th and 24th months (n = 8), and non-CR 24-month-old animals (n = 8). We investigated 16 previously validated biomarkers of macromolecular redox homeostasis, ranging from protein and lipid oxidation to glycation and antioxidative capacity. In the present study, the protein, lipid and antioxidant capacity redox homeostasis biomarkers overwhelmingly indicate that, CR, even though not started very early in adulthood, could still offer potential therapeutic effects and it could significantly improve various redox homeostasis biomarkers associated with disease reliably in the heart tissue of aging male Sprague-Dawley rats. Therefore, the effects of CR likely operate through similar mechanisms throughout adulthood and CR seems to have real ameliorative effects on organisms that are not due to confounding factors that come from ad libitum fed rats.

Protective Effects of Ursolic Acid in the Kidneys of Diabetic Rats

Objectives

Diabetes, a heteregenous metabolic and chronic disease, is a growing health problem in most countries. It has been claimed that diabetes is associated with the increased formation of free radicals and decreased in antioxidant potential. Oxidative stress formed in diabetes may cause DNA damage in the tissues. Ursolic acid, a well-known pentacylic triterpene, is commonly used in traditional Chinese medicine due to its beneficial health effects such as antioxidant, anticancer, and antiulcer properties. The aim of this study was to investigate the effects of ursolic acid in the kidneys of Wistar albino rats with streptozotocin-induced diabetes.

Materials and Methods

DNA damage was evaluated in the kidney cells of rats using alkaline comet assays. Oxidative stress parameters such as CAT, SOD, GR, and GSH-Px enzyme activities and total GSH and MDA levels were also evaluated.

Results

Ursolic acid treatment was found to significantly decrease DNA damage, GR enzyme activities, and MDA levels, and significantly increase GSH levels and CAT, SOD and GSH-Px enzyme activities in diabetic rats.

Conclusion

According to our results, it seems that ursolic acid may be beneficial against diabetes-induced renal damage.

Neutron Skin Effects in Mirror Energy Differences: The Case of ^{23}Mg-^{23}Na

Energy differences between analogue states in the T=1/2 ^{23}Mg-^{23}Na mirror nuclei have been measured along the rotational yrast bands. This allows us to search for effects arising from isospin-symmetry-breaking interactions (ISB) and/or shape changes. Data are interpreted in the shell model framework following the method successfully applied to nuclei in the f_{7/2} shell. It is shown that the introduction of a schematic ISB interaction of the same type of that used in the f_{7/2} shell is needed to reproduce the data. An alternative novel description, applied here for the first time, relies on the use of an effective interaction deduced from a realistic charge-dependent chiral nucleon-nucleon potential. This analysis provides two important results: (i) The mirror energy differences give direct insight into the nuclear skin; (ii) the skin changes along the rotational bands are strongly correlated with the difference between the neutron and proton occupations of the s_{1/2} "halo" orbit.

Defining and Measuring a Standard Set of Patient-Relevant Outcomes in Coronary Artery Disease

Systematic outcome measurement enables to continuously improve treatment results and stimulates dissemination of best practices. For patients with coronary artery disease, no examples yet exist of standard sets of patient-relevant outcome measures that have already been fully implemented at a large scale in clinical care. The aim of this paper is twofold: (1) to share the standard set of outcome measures as developed by Meetbaar Beter, and (2) to show how the standard set is presented and published to support improvement of cardiac care. A step-wise approach was followed by an expert panel to construct a standard set of outcome measures. This resulted in a comprehensive set of relevant outcome measures, comprising 4 generic and 11 treatment-specific outcomes. Both short-term and long-term outcomes measures up to 5 years of follow-up were included. Relevant initial conditions were selected to enable case-mix adjustment. The standard set has been implemented in 21 hospitals across the Netherlands. The results and experiences have been used to fine-tune the set in 4 reporting cycles in 2012 to 2016, using an annual maintenance cycle. Currently about 83,000 percutaneous coronary interventions and 30,000 coronary artery bypass graftings are included in the dataset, covering the majority of all percutaneous coronary interventions and coronary artery bypass graftings in the Netherlands. In conclusion, Meetbaar Beter has defined and implemented a comprehensive set of patient-relevant outcome measures for coronary artery disease, and the variation of the results among the centers indicates that there are sufficient opportunities to further improve cardiac care in the Netherlands.