Impact of sarcopenia on overall survival and local relapse in head and neck cancer patients undergoing surgical excision

OBJECTIVE

The purpose of this study is to evaluate the effect of sarcopenia on overall survival and local relapse in head and neck cancer patients undergoing surgical excision.

PATIENTS AND METHODS

This retrospective study includes head and neck cancer patients primarily treated with surgical excision in a tertiary care center. Patients were included if they had undergone an abdominal region Computer Tomography scan at least 45 days before the surgical excision. Hospital records were collected, and data analysis included patient demographics, comorbidities, tumor staging, surgical details, adjuvant therapy details, treatment complications, death records, and last follow-up appointment details.

RESULTS

In this retrospective study, 138 head and neck cancer patients were included, with 69.6% males and 30.4% females. The mean age was 60.2±12.3 years, and the average follow-up time was 54.3±16.3 months. Sarcopenia was present in 48.6% of patients and absent in 51.4%. Sarcopenic patients had a significantly lower mean age compared to non-sarcopenic patients (p<0.05). The proportion of larynx cancer was significantly lower in the sarcopenia group compared to the non-sarcopenia group (p<0.05). According to the American Joint Committee on Cancer (AJCC) staging, stage IV was significantly higher in the sarcopenia group (p<0.05). Local relapse was significantly higher in the sarcopenia group (p<0.05).

CONCLUSIONS

The findings of this study emphasize the importance of sarcopenia evaluation in determining prognosis and identifying patients who may benefit from specialized and intensive nutritional programs. Sarcopenia harms overall survival and local relapse in head and neck cancer patients.

Effects of alkaline pH and gallic acid enrichment on the physicochemical properties of sesame protein and common vetch starch-based composite films

In this study, sesame (Sesamum indicum L.) meal protein and common vetch (Vicia sativa L.) starch were extracted and used to obtain biodegradable composite films at different pH values (7, 9, and 11). Films were plasticized with glycerol (2.5 %) and enriched with gallic acid (0.25 %). Increasing pH promoted mechanical properties of the films with the developed barrier and thermal characteristics. Gallic acid addition at pH 7 resulted in lower tensile strength and higher elongation by reducing intermolecular forces, and a shift of diffraction peaks through lower angles due to crystal lattice expansion, as compared to neutral films without gallic acid. On the other hand, gallic acid-enriched films at neutral pH exhibited superior antioxidant properties. The mild alkalinity with gallic acid provided the lowest water vapor permeability, high thermal stability, improved mechanical properties and light barrier property due to deprotonation and subsequent interactions with biopolymers. The FTIR spectrum confirmed intense interactions, such as crosslinking and covalent bonding, promoted by mild alkalinity. Therefore, sesame protein and common vetch starch-based composite film with gallic acid incorporation at pH 9 can be recommended to be used in biodegradable active food packaging applications.

The relationship between temporal muscle thickness and disease activity in Cushing's disease

OBJECTIVE

This study aimed to investigate the relationship between hypercortisolism and temporal muscle thickness (TMT) in Cushing's disease (CD).

METHODS

A retrospective review of medical records was conducted for patients with CD who presented to our clinic between 2012 and 2022. Biochemical data and TMT measurements from sella imaging were evaluated during diagnosis and the first postoperative year.

RESULTS

A total of 44 patients were included in the study, with an average age of 43.9 years, of which 38 were female. The mean TMT at the time of diagnosis was 19.07 ± 1.71 mm, with no significant difference between males and females (p = 0.097), and no correlation between the TMT and age at diagnosis (p = 0.497). There was an inverse relationship between TMT and serum cortisol levels, 24-h UFC, and midnight salivary cortisol at the time of diagnosis of CD (p < 0.05, for all). One year after surgery, TMT significantly increased in all patients compared to baseline (p < 0.001). Furthermore, patients who achieved postoperative remission had significantly higher TMT values compared to those who did not achieve remission (p = 0.043). Among the patients who achieved remission, those who achieved remission through surgery had significantly higher TMT compared to those who could not reach remission with surgery and patients who started medical treatment and achieved biochemical remission (p = 0.01). Patients with severe myopathy and sarcopenia had significantly lower TMT values than the others (p < 0.001).

CONCLUSION

Temporal muscle thickness was found to be associated with disease activity and disease control in Cushing's disease.

The Effects of Citric Acid Crosslinking on Fabrication and Characterization of Gelatin/Curcumin-Based Electrospun Antioxidant Nanofibers

Nanofibers, produced through the novel method of electrospinning, have a high ratio of surface area to volume, which allows them to have different optical, electrical, thermal, and mechanical properties than macroscale materials. In this study, it was aimed to produce nanofibers with gelatin and curcumin. The effects of gelatin concentration and crosslinking with citric acid on the characteristics of electrospun nanofibers were studied. Gelatin film containing neither citric acid nor curcumin was used as control. Solutions were evaluated by solution conductivity, color analysis, and rheological properties. Obtained nanofibers were characterized by morphological analysis (SEM), antioxidant activity (AA), thermal properties (TGA, XRD, DSC), water vapor permeability (WVP), and Fourier transform infrared (FTIR) analysis. It was found that the functional groups of gelatin were not changed significantly but some degree of crosslinking was seen, as indicated by the changes in AA, crystallinity, etc. Improvement in antioxidant activities was seen, which was the highest for gelatin and curcumin films (32%). The highest melting temperature (78 °C) and WVP (2.365 × 10^-10 gm^-1 s^-1 Pa^-1) was seen for gelatin and curcumin films crosslinked with 0.5% citric acid. Gelatin with curcumin films crosslinked with 1% citric acid showed the lowest crystallinity (1.56%). It was concluded that even though citric acid might not prove to be a stable crosslinking agent for the protein (gelatin), it contributed to the antioxidant nature of the films, along with curcumin. These films are promising candidates to be applied on cut fruits, to reduce water loss and oxidation and hence extend their shelf lives.

Juvenile and adult-onset scleroderma: different clinical phenotypes

OBJECTIVES

Systemic sclerosis (SSc) represents extremely rare disease with majority of data coming from adults. Studies comparing juvenile- (jSSc) and adult-onset (aSSc) patients are limited. We aimed to compare clinical features, treatment modalities and survival rates of jSSc and aSSc patients.

METHODS

A retrospective study among pediatric and adult Scl patients has been performed. Demographic characteristics, clinical features, autoantibody profiles, and treatment data were retrieved from the databases. Survival analysis was done using Kaplan-Meier plot and factors associated with mortality were identified with multiple regression analysis.

RESULTS

A total of 158 adults and 58 juvenile Scl patients were identified. The mean age at the disease onset was 37±14.7 vs. 8.8 ± 4.1 years, mean age at diagnosis 42±15.2 vs. 10.4 ± 3.8 years and mean follow-up duration was 6.3 ± 4.9 years vs. 6.6 ± 4.9 years for aSSc and jSSc patients, respectively. The frequency of interstitial lung disease (ILD) (50.9% vs 30%, p<0.001) and systemic hypertension (17.9% vs 0, p = 0.009) was significantly higher among aSSc. While aSSc patients had presented mostly with limited cutaneous subset (74.1%), diffuse cutaneous subset was the dominant subset among jSSc (76.7%), (p<0.001). The mortality rate was significantly higher among adults (p = 0.005). The ILD (p = 0.03) and cardiac insufficiency (p = 0.05) were independent risk factors of mortality in both aSSc and jSSc patients.

CONCLUSION

Juvenile and adult-onset Scl represent rarely seen conditions with different clinical phenotypes. Pediatric patients with LS are more commonly seen by pediatric rheumatologists, in contrary to adults. Diffuse disease subset is the dominant form among juvenile patients, whereas limited form is the main disease subset among adults. On the other hand, juvenile-onset patients have a better survival than those with adult-onset.

Predictors of successful vaginal birth after a caesarean in women with a previous single caesarean delivery

OBJECTIVE

The aim of our study was to present our case series of the trial of labor after a caesarean (TOLAC) and determine significant predictors for a successful vaginal birth after a caesarean (VBAC).

PATIENTS AND METHODS

Women with previous single caesarean deliveries who underwent TOLAC between January 2016-December 2019 were included in the study (n = 474). All files were analyzed in terms of demographic characteristics, obstetric history, history of index pregnancy and medical characteristics of previous caesarean delivery. For each current pregnancy, we recorded time from the previous delivery, the BISHOP and TOLAC scores at admission, induction of labor, gestational age at delivery, estimated fetal weight, intrapartum characteristics, mode of delivery and intra-operative findings.

RESULTS

Among 474 women who had a previous caesarean delivery and gave consent for TOLAC, 216 resulted in a successful vaginal delivery, whereas 258 underwent repeat caesarean delivery. One hundred and seventy-nine women gave up trial of vaginal delivery during labor. The success rate of VBAC after exclusion of caesarean cases due to maternal requests was 73.2%. The induction rate was significantly higher in cases with successful VBAC (40% vs. 29.1%). The risk of uterine rupture was 0.42% in cases with labor induction. ROC analysis showed significant predictive values of the TOLAC score, body mass index (BMI), the number of previous VBACs and the number of previous vaginal deliveries, birth weight and the BISHOP score at admission.

CONCLUSIONS

Our data showed us that major determinants for successful VBAC following labor are the BISHOP score at admission, number of previous vaginal deliveries, body mass index, birth weight and the TOLAC score calculated at admission.

Quantitative Analysis of the Olfactory System in COVID-19: An MR Imaging Study

BACKGROUND AND PURPOSE

Anosmia or hyposmia, often accompanied by changes in taste, is recognized as a common symptom that can assist in the diagnosis of coronavirus disease 2019 (COVID-19). The pathogenesis of olfactory dysfunction in COVID-19 is not yet fully understood. MR imaging represents a useful anatomic imaging method for the evaluation of olfactory dysfunction associated with varying etiologies, including viral infection, trauma, and neurodegenerative processes. This case-control study was conducted to compare quantitative measurements of olfactory anatomic structures between patients diagnosed with COVID-19 associated with persistent olfactory dysfunction and healthy controls.

MATERIALS AND METHODS

This study has a retrospective design. Cranial MR imaging was performed on all participants in both the patient and control groups. The bilateral olfactory bulb volume, olfactory tract length, and olfactory sulcus depth were measured in all patients.

RESULTS

A total of 116 people aged 18-60 years, including 36 patients diagnosed with COVID-19 and 80 controls, were included in the study. All measured values were compared between the patient and control groups. The right, left, and total olfactory bulb volume values were significantly lower in the patient group than in the control group. The patient group also had significantly lower right and left olfactory sulcus depth and olfactory tract length values compared with those in the control group.

CONCLUSIONS

MR imaging findings can be used to demonstrate olfactory injury in patients with COVID-19. The olfactory pathway may represent an alternative route for virus entry into the central nervous system.

Correlation between physical and sensorial properties of gummy confections with different formulations during storage

Gummy confections are popular products formulated with sucrose, glucose syrups, gelling agents, acids, flavourings and colouring agents. They have various commercial types in terms of formulation, texture, taste and colour, however, there is inadequate investigation on storage behavior of these products. The aim of this study is to investigate the effects of glucose syrup:sucrose ratio (1.1 and 1.5), starch (0% and 1.5%) and gelatine concentration (3% and 6%) on texture profile, colour and sensory properties of gummy confections during storage. It was also aimed to correlate sensorial changes with physical properties measured by instrumental techniques during storage at 10 °C, 20 °C and 30 °C. The highest increase in hardness was observed for formulation with 1.1 glucose syrup:sucrose ratio, no starch and 6% gelatine. Storage temperature had no significant effect on cohesiveness. It was seen that rate of colour change increased with storage time and temperature. Formulation with glucose syrup:sucrose ratio of 1.5, no starch and 6% gelatine had the highest sensory scores. This formulation was found to be the most stable formulation in terms of hardness and gumminess, meaning that it would need a stable mastication during storage. Sensorial changes of gummy confections were found to be correlated with instrumental results of texture and colour.

POS1375 THE EFFECT OF M694V HOMOZYGOSITY ON THE CAROTID INTIMA-MEDIA THICKNESS AND FLOW MEDIATED DILATATION IN PATIENTS WITH FMF RELATED AMYLOIDOSIS

Background:

There are limited data in FMF associated AA amyloidosis patients regarding the vascular abnormalities including atherosclerosis and endothelial dysfunction, all of which are contributors of cardiovascular disease (CVD) risk. And, this risk assessment for future CV events have not yet been evaluated between FMF amyloidosis patients with different genotypes.

Objectives:

We aimed to compare early markers of endothelial dysfunction and atherosclerosis, mortality and other disease characteristics in FMF-related amyloidosis patients with a homozygous M694V genotype and in patients with other genotypes with this cross-sectional comparative study.

Methods:

For this purpose, patients with FMF-related amyloidosis were assigned according to the MEFV gene mutation to one of the two groups. Group 1: Patients homozygous for M694V (which is the most common genotype associated with the most severe clinical phenotype in FMF) Group 2: Patients homozygous (other than M694V) or compound heterozygous (including M694V) for other MEFV variants. Potential confounders were controlled by excluding the patients with untreated hypertension, diabetes mellitus, obesity, smoking, previous history of CVD low glomerular filtration rate (eGFR <70 mL/min). Flow-mediated dilatation (FMD), pentraxin-3 (PTX3) as early markers of endothelial dysfunction and carotid intima-media thickness (cIMT), fibroblast Growth Factor 23 (FGF23) as an indicator of atherosclerotic vascular disease, all of which are non-invasive tests that are also used to identify subjects at increased risk for future CV events were measured in these 2 groups.

Results:

We analyzed demographic, clinical, genetic, survival data and these non-invasive markers of endothelial dysfunction (FMD and PTX3) and atherosclerosis (cIMT and FGF23) in 76 FMF amyloidosis patients with homozygous M694V mutations (Group 1) and 93 FMF amyloidosis patients with two pathogenic mutations apart from M694V homozygosity (Group 2) (Table 1). Brachial artery FMD was significantly lower in Group 1 when compared with Group 2 subjects (6.0 vs. 6.5%, p<0.001). cIMT, FGF23 and PTX3 levels were higher in Group 1 when compared with Group 2 (cIMT: 0.84 vs. 0.67 mm, p<0.001; FGF23: 52.4 vs. 38.0 pg/dL, p=0.01; PTX3: 14.0 vs. 3.2 ng/mL, p<0.001). Time to develop amyloidosis was similar in patients homozygous for M694V (median 10.0 years, 95%CI: 8.99-11.0) and in Group 2 (median 10.0 years, 95%CI: 8.97-11.0) (p>0.05). Mortality rate was significantly higher in Group 1 compared to Group 2 (18.4% vs. 1.1%, p<0.001) over a median of 7.8 years of follow-up. FMF amyloidosis patients homozygous for M694V had reduced survival (mean survival: 97 months, 95%CI: 94.9 to 101.0 months) as compared to Group 2 (mean survival: 100.7 months, 95%CI: 100.0 to 101.3 months) (p<0.001) (Figure 1). The proportion of the clinical manifestations including fever, serositis, erysipelas-like erythema, all of which are associated with an FMF attack did not differ between two groups (p>0.05) apart from arthritis (76.3% in Group 1 and 59.1% in Group 2, p<0.05) (Table 1).

Conclusion:

In patients with FMF related amyloidosis, M694V homozygosity is associated with lower FMD values and higher cIMT, FGF23 and PTX3 levels. In summary, the data demonstrate that a genotype-phenotype association exists in terms of endothelial dysfunction and atherosclerosis in FMF patients with amyloidosis.

Table 1.Group 1 (n=76)Group 2 (n=93)Total (n=169)pClinical Findingsn (%)n (%)n (%)Dialysis2 (2.6)3 (3.2)5 (3.0) 1.00*Kidney transplantation5 (6.6)4 (4.3)9 (5.3)0.73*Kidney biopsy68 (89.5)85 (91.4)153 (90.5)0.67Median(Min-max)Median(Min-max)Median(Min-max)Age (years)36.5 (19.0-49.0)35.0 (22.0-49.0)36.0 (19.0-49.0)0.16Age of amyloidosis (years)20.0 (13.0-31.0)20.0 (15.0-26.0)20.0 (13.0-31.0)0.86BMI (kg/m2)26.0 (21.0-32.0)27.0 (19.0-32.0)26.6 (29.0-32.0)0.89HOMA2.2 (1.2-7.3)2.4 (1.1-8.4)2.4 (1.1-8.4)0.40Proteinuria (g/24h)7.64,65.4<0.001

Disclosure of Interests:

None declared

NMR Relaxometry and magnetic resonance imaging as tools to determine the emulsifying characteristics of quince seed powder in emulsions and hydrogels

Quince seed powder (QSP) is known to exhibit emulsification properties and could be used as a natural emulsifier in colloidal food systems. In this study, emulsion-based alginate hydrogels were formulated using QSP and xanthan gum (XG) as stabilizers. The objective of the study was to show the emulsifying power of QSP in emulsions and their hydrogels using Time Domain (TD) NMR Relaxometry and Magnetic Resonance Imaging (MRI). Rheology and mean particle size measurements for emulsions and scanning electron microscope (SEM) experiments for hydrogels were further conducted as complementary methods. QSP containing emulsions were found to have longer T₂ relaxation times than XG samples (p < 0.05). Addition of either QSP or XG produced a more pseudoplastic flow behavior (p < 0.05) on the emulsions. Relaxation times were also obtained by MR images through T₂ maps. Relaxation decay curves showed the presence of two proton compartments in hydrogels; protons associated with the polymer matrix and protons interacting with the oil phase. The contribution of the first proton pools was the largest in QSP hydrogels confirmed by the lowest standard deviation in the T₂ maps. This behavior was explained by the emulsification ability of QSP. Results showed that NMR Relaxometry and MR images could be used to understand the emulsifying nature of QSP and many other hydrocolloids.

Quantitative analysis of healthy olfactory sulcus depth, olfactory tract length and olfactory bulb volume in the paediatric population: a magnetic resonance study

BACKGROUND

The aim of this study was to determine the normal reference values for olfactory sulcus depth, olfactory tract length and olfactory bulb volume in the paediatric population with routine magnetic resonance imaging (MRI) and determine the relationship, if any, between these values and patient sex and age.

MATERIALS AND METHODS

Ninety patients with a median age of 8 years (age range: 3-17 years), consisting of 45 males and 45 females with normal brain MRI scans were evaluated. The patients were divided into three subgroups based on age range, with n = 30 per subgroup; group 1: young children (3-6 years), group 2: children (7-11 years) and group 3: adolescents (12-17 years). In the cranial MRI examination of all groups, the right, left and total olfactory bulb volume values were measured in mm3, the right and left olfactory tract length values and the right and left olfactory sulcus depth values were calculated manually in mm. Demographic data including sex and age were recorded.

RESULTS

There was no significant difference between the age groups in terms of sex. Right-left olfactory sulcus depth; right-left olfactory tract length and right-left total olfactory bulb volume values increased significantly when they are compared in terms of age groups (p < 0.0001, = 0.028; < 0.0001, < 0.0001; < 0.0001, < 0.0001; < 0.0001, respectively). There was no significant difference between right and left olfactory tract length and olfactory bulb volumes in all groups (p = 0.792 and p = 0.478), but the right olfactory sulcus depth was significantly larger than the left (p = 0.003).

CONCLUSIONS

Especially as the age progresses, olfactory tract length and olfactory bulb volume dimensions of olfactory nerve and olfactory sulcus depth should be checked during diagnosis of respective illnesses in paediatric population.

Development of relationship with patient self efficacy scale: Gender, department, and grade level differences

Background

Self-efficacy has become a cross-disciplinary concept. In the field of healthcare, this concept is considered crucial for nurses; who play an important role in improving the health and well-being of the community.

Aims

The aim of this study was to develop a "Relationship-with-the-patient self-efficacy scale" (RPSES).

Methodology

A sample of 331 university students (310 females and 21 males; 168 from the midwifery and 162 from the nursing departments) were enrolled in the study. Out of 24 items, 8 behavior items with the highest factor loadings were selected regarding the nurse-patient-relationship self-efficacy according to the results of the preliminary exploratory factor analysis.

Results

The final exploratory factor analysis revealed that the selected 8 items of RPSES had a single factor, explaining 83.28% of the total variance. The Cronbach alpha reliability coefficient was c alculated as 0.97.

Conclusion

This scale has beendemonstrated to be a valid and reliable instrument.The analyses unfolded that RPSES scores of the students were not different between men and womenand did not differ by the departments the students attended; however, the RPSES scores were different by the grade levels of the students (juniors and seniors). The fourth graders' RPSES scores were higher than those of third graders.

Encapsulation of pea protein in an alginate matrix by cold set gelation method and use of the capsules in fruit juices

Plant-based proteins gained importance in recent years due to the increase in the awareness of healthy diet and in the consumption of plant-based foods. However, some features of plant-based proteins like the undesirable odor and flavor affect the sensorial properties of protein containing foods. Therefore, encapsulation of these proteins could be a good strategy to tackle with this problem. The objective of this study was to design microcapsules (beads) consisting of pea protein by using sodium alginate and to investigate the effect of different alginate concentrations (1.0, 1.5, and 2.0%) on the protein content, encapsulation efficiency, particle size, bead stability, and the morphology of the capsules and then add them to different fruit juices (pomegranate and melon) and examine the release behavior from the capsules. Rheological behavior of the juices including pectin were also investigated. TD- nuclear magnetic resonance relaxometry analysis through T₂ relaxation times was conducted on the capsules to observe the changes in the beads. In conclusion, alginate was found to be a suitable encapsulation coating for pea protein. Beads containing 1% alginate concentration was found to be the most effective with respect to protein content and bead stability. PRACTICAL APPLICATION: This study aims to design and characterize pea protein containing microcapsules capsules and their utilization in fruit juices. The study itself focused on a specific application on the fruit juices.

FRI0455 IS THERE AN INCREASE IN THE FREQUENCY OF INFLAMMATORY DISEASES IN THE FAMILIES OF PATIENTS WITH FMF?

Background:

Familial Mediterranean Fever (FMF) is the most common periodic fever syndrome in childhood with an autosomal recessive inheritance pattern and is characterized by unprovoked fever attacks, serositis episodes. The causative gene of the disease is MEFV that encodes pyrin protein. The pyrin protein takes a role in pathways related to inflammation, and mutations of it lead to increased inflammation. It is already shown that frequencies of some certain diseases like PAN, HSP increase in patients with FMF. Nevertheless, frequencies of inflammatory diseases in families of patient with FMF haven’t been investigated.

Objectives:

In this study, we have aimed to evaluate the comorbid disorders in a large cohort of families of patients with FMF.

Methods:

Four hundred and ninety-eight children with FMF, one hundred and forty patients with JIA and ninety-two healthy children were interviewed between December 2019 and January 2020. In JIA group and healthy control group, patients who have family history for FMF were excluded from the study. Patients were asked about characteristics of their disease attacks and if there is a relative with any inflammatory diseases who does not have FMF in patient’s 1stand 2th degree relatives.

Results:

Demographic features of study group have shown in Table 1. The most common MEFV mutations in patients with FMF were: M694V homozygotes (13.2 %), M694V heterozygotes (12 %), M694V homozygotes and R202Q homozygotes (6,8 %). Type II diabetes, asthma and hypothyroidism were the most commonly detected diseases in all cohorts. Frequency of Behçet’s disease, allergic rhinitis and type II diabetes were significantly higher in families of patients with FMF than other groups (p<0.05) (Table 2).

Table 1.

Demographic features of study population.

FMF†JIA††Healthy Controln: 498 (%)mean +/- SDn: 140 (%)mean +/- SDn: 92 (%)mean +/- SDFemale284 (57)91 (65)55 (59.8)Age (years)12.9 ± 8.211.7 ± 5.17.4 ± 4.6Age at Onset (years)4.3 ± 3.35.4 ± 4.1-Age at Diagnosis (years)6.3 ± 3.66.3 ± 4.5-Delay in Diagnosis (months)23.8 ± 29.211.3 ± 28.2-Follow-up Duration (years)6.9 ± 8.35.3 ± 4.0-Consanguinity100 (20)25 (17.8)8 (8.6)Family History of FMF282 (56.6)0 (0)0 (0)JIA subgroup-- Oligoarticular72 (51.4) Polyarticular (RF negative)16 (11.4) Polyarticular (RF positive)3 (2.1) Enthesitis Related Arthritis14 (10) Psoriatic Arthritis7 (5) Systemic23 (16.4) Other5 (3.5)Clinical Findings-- Fever392 (78.1) Abdominal Pain429 (86.1) Chest Pain102 (20.5) Arthralgia334 (67.1) Arthritis157 (31.5) Extremity Pain64 (12.8) Heel Pain44 (8.8) Myalgia43 (8.6) *ELE13(2.6) Serositis10 (2)

†Familial Mediterranean Fever††Juvenile Idiopathic Arthritis*Erysipelas like erythema

Table 2.

Comparison of frequencies of diseases detected among families of patient groups (shortened).

DiseasesFMFJIAHealthy Controlp1Type II Diabetes284 (57)64(45.7)44 (47.8)0.02Asthma139 (27.9)30 (21.4)20 (21.7)0.19Hypothyroidism122 (24.4)27 (19.2)14 (15.2)0.09Eczema68 (13.6)14 (10)5 (5.4)0.06Psoriasis49 (9.8)6 (4.2)7 (7.6)0.10Allergic Rhinitis49 (9.8)3 (2.1)1 (1)0.001Hyperthyroidism40 (8)9 (6.4)3 (3.2)0.24Behçet’s Disease31 (6.2)1 (1)2 (2.1)0.01Rheumatic Fever30 (6)10 (7.1)2 (2.1)0.25

Conclusion:

In this study, we have reported increased frequencies of Behçet’s disease, allergic rhinitis and type II diabetes in families of patients with FMF. Our results suggest that possible increased mutation load among families of patients with FMF may cause increased inflammatory diseases.

References:

[1]Yildiz M, Adrovic A, Tasdemir E, et al. Evaluation of co-existing diseases in children with familial Mediterranean fever.Rheumatol Int. 2020;40(1):57–64. doi:10.1007/s00296-019-04391-9

Disclosure of Interests:

None declared

AB1325-HPR THE TRANSITION FROM PEDIATRIC TO ADULT RHEUMATOLOGY OF 347 PATIENTS AT A SINGLE CENTER

Background:

Pediatric to adult rheumatology transition can be a challenge for both the patient and the clinician, especially in rheumatology as it includes chronic diseases with close follow-up.

Objectives:

The objective of this study is to understand our tertiary rheumatology center patient demographic transitioning from pediatric to adult rheumatology in order to design prospective studies enhancing the evidence of transition recommendations.

Methods:

Patients included in this study are regularly followed-up in our adult rheumatology clinic and were regularly followed up in our pediatric rheumatology clinic in the past. They were all diagnosed with a rheumatologic condition receiving treatment. The patient files were assessed to have a better understanding of their demographic, disease and treatment information.

Results:

Our cohort includes 347 patients diagnosed with a variety of conditions that are Familial Mediterranean Fever (FMF) (n=216), Juvenile Idiopathic Arthritis (JIA) (n=56), Juvenile Spondyloarthritis (jSPA) (n=39), Systemic Lupus Erythematosus (SLE) (n=20), Behçet’s Disease (n=7) and the rest of the rheumatologic conditions with less than 5 patients each. The mean age of the patients during transition, mean age of diagnosis, and follow-up duration are 21.34±1.7, 10.4±4.18, and 10.82±4.4 in respective order. The treatment regimens the patients received are summarized in Table 1.

Table 1.

Current Treatment Information of the Patients

Current Treatment InformationDMARD26Colchicine23Adalimumab21Etanercept10NSAID4Tocilizumab3Cyclophosphamide3Rituximab2Prednisolone7Mycophenolate Mofetil1Canakinumab1

Seven patients had FMF related attacks. In addition to attacks, one FMF patient had bilateral ankle pain and one patient had leg pain. One patient out of three diagnosed with Takayasu’s disease was still symptomatic. One patient had uveitis-related symptoms. One patient diagnosed with SLE had skin dryness. Furthermore, there were patients with sequelae formation. One patient diagnosed with oligoarticular JIA (oJIA) had bilateral hip sequela with the additional left hip prosthesis. One oJIA patient had micrognathia, and one had left knee sequela. One pJIA patient had small joint sequelae. One sJIA patient had bilateral hip sequelae. One jSPA patient had enthesopathy. One FMF patient had proteinuria due to amyloidosis formation. Another FMF patient had hip surgery due to sequela.

Conclusion:

Our center had patients with a variety of conditions with different natures of diseases. EULAR recommends the transition process to start no later than 14 years of age; however, this process started at the mean age of 21 in our patients. In most of these patients, especially the ones diagnosed with FMF, the control of disease activity was maintained. The transition of these different clinical entities might require certain amendments to the standard of care. For future references, we will be able to understand more about the adulthood prognosis of these clinical entities.

Disclosure of Interests:

None declared

THU0308 COMPARISON OF CHILDHOOD-ONSET VERSUS ADULT-ONSET TAKAYASU ARTERITIS: A STUDY OF 141 PATIENTS FROM TURKEY

Background:

Childhood-onset Takayasu Arteritis (c-TAK) may differ from adult-onset Takayasu Arteritis (a-TAK) in clinical maaifestations and treatment.

Objectives:

To compare c-TAK with a-TAK patients for vascular involvement, disease activity, damage, and treatment.

Methods:

Patient charts from two tertiary-care centers of a pediatric and adult clinic were reviewed. Adult patients diagnosed before the age of 18 were included in the c-TAK group. The activity was assessed with the physician’s global assessment (PGA) and Indian Takayasu Clinical Activity Score (ITAS). The damage was evaluated with Takayasu Arteritis Damage Score (TADS) and Vasculitis Damage Index (VDI).

Results:

Twenty four c-TAK and 121 a-TAK patients were compared. 21 (88%) of the c-TAK group and 104 (89%) of the a-TAK group were female. Age at symptom onset was 14 (IQR: 9-15) for c-TAK and 30 (IQR: 24-43) for a-TAK patients. Diagnostic delay in months was shorter for c-TAK patients [c-TAK: 3 (1-10) vs. a-TAK: 12 (5-58)]. Follow-up duration was similar [53 months (IQR: 16-131) vs. 68 (IQR: 30-102), p=0.763].

ITAS was comparable for c-TAK and a-TAK patients on the first visit [14 (SD: 7) vs. 13 (SD: 5), p=0.362, respectively]. However, the PGA score was higher in the c-TAK group compared to the a-TAK group [9 (IQR 7-10) vs. 7 (IQR 6-8), p<0.001].

14 (64%) of c-TAK patients and 10 (9%) of a-TAK patients received pulse glucocorticoids, p= 0.002. Cumulative glucocorticoid dose was 10 grams (IQR: 6-13) for c-TAK patients and 7 grams (IQR: 4-12) for a-TAK patients (p=0.128).

After diagnosis, children had more vascular interventions than the adults did [9 (38%) vs. 20 (18%), p=0.031, respectively].

Rates of achieving at least one remission were lower for c-TAK patients [c-TAK: 12 (50 %) vs. a-TAK: 94 (82%), p=0.001]. c-TAK patients had a PGA score of 6 (IQR 3-8), the PGA score in a-TAK patients was 1 (IQR 1-3), p<0.001. Still, ITAS was similar for both groups [c-TAK: 1 (IQR 0-3) vs. a-TAK: 0 (IQR 0-2), p= 0.579]. 9 (38%) of c-TAK patients had at least one relapse, and the 43 (38%) of a-TAK patients had at least one relapse (p=0.960).

TADS was similar [c-TAK: 8 (IQR 4-12), a-TAK: 8 (IQR 6-10), p=0.919]. However, VDI of the a-TAK patients was higher than the c-TAK patients [c-TAK: 4 (IQR 2-5), a-TAK: 5 (IQR 3-7), p=0.017]. Glucocorticoid related damage was higher in a-TAK patients (Diabetes: 8% vs. 4%, avascular necrosis: 6% vs. 0, and cataracts: 11% vs. 0)

Conclusion:

Aorta involvement, biologic agent use, and vascular interventions were more common in c-TAK patients. However, cumulative damage was not increased for c-TAK patients which may be partly explained by more common corticosteroid related side-effects in adults.

Table 1.

Baseline symptoms, physical examination findings*

c-TAK (n= 24)a-TAK (n= 117)pSYMPTOMSStroke1 (4)8 (7)1Carotidynia019 (16)0.044Upper Extremity Claudication5 (21)72 (62)<0.001Hypertension13 (54)22 (19)<0.001Pulse loss (Radial)8/23 (35)62 (58)0.043BRUITSubclavian8 (35)62 (57)0.054Renal9 (39)15 (14)0.014Abdominal Aorta11 (48)9 (8)<0.001

*Values denote the number (%) of patients

Figure 1.

Comparison of involved arteries* * Numbers in bars represent percentage of patients in each group

Figure 2.

Angiographic classification types according to Hata* * Numbers in bars represent percentage of patients in each group. Type 2a and Type 2b are combined. a-TAK group had no patient with Type 3 disease

Table 2.

Medical treatment*

First TreatmentTreated Everc-TAK (n=22)a-TAK (n=115)pc-TAK(n=24)a-TAK (n=114)pMethotrexate5 (23)69 (60)0.00112 (50)76 (67)0.123Azathioprine8 (36)38 (33)0.76321 (88)79 (69)0.070Leflunomide01 (1)13 (13)35 (31)0.070Cyclophosphamide†6 (27)6 (5)0.00412 (50)10 (9)<0.001Biologics10 (42)16 (14)0.004Anti-TNF---4 (17)18 (16)-Tocilizumab---7 (29)4 (4)-

*Values denote the number (%) of patients.

Disclosure of Interests:

None declared

AB1011 LONG TERM FOLLOW-UP of THE PATIENTS WITH ANTI NUCLEAR ANTIBODY POSITIVITY WHO HAD INITIALLY NO IDENTIFIABLE RHEUMATIC DISEASES

Background:

Anti-nuclear antibodies (ANA) are a group of the antibodies that develop against intracellular components of the cells. It is usually useful for diagnosing some of the connective tissue diseases like systemic lupus erythematosus, mixed connective tissue disease. But it is reported that its positivity rate is about %20 in healthy individuals. Therefore, it can be confusing to check ANA test, if there is not really high suspicion for connective tissue diseases or juvenile idiopathic arthritis.

Objectives:

We aimed to evaluate results of long-term follow-up of the patients with ANA positivity who had initially no identifiable rheumatic diseases.

Methods:

Six hundred and ninety-four patients with ANA positivity who did not diagnosed as any of the rheumatic diseases at the first examination were found in database. Two hundred and eighty- two patients of them were called so far and questioned about their demographic features and symptoms that are related with rheumatic diseases.

Results:

Mean age of the patients at the time of study and at the time of testing were 13.4± 4.5 and 9.1±4.0 years. The female: male ratio was 1.05. Mean follow-up duration was 4.3±2.8 years. Most common reasons for the request for ANA test were arthralgia and skin eruptions. ANA testing was most commonly requested by a general pediatrists. Demographic features of the patients were summarized in Table 1.

Table 1.

Demographic features of the patients.

n (%)Age (years)13.4± 4.5Female145 (51.4)Age at the time of testing (years)9.1±4.0Follow-up Duration (years)4.3±2.8Reason for testing Arthralgia99 (44.1)Skin Eruption54 (24.1)Check-Up20 (8.9)Arthritis13 (5.8)Gait abnormalities7 (3.1)Hair Loss6 (2.6)Fever5 (2.2)Uveitis2 (0.8)Recurrent abdominal pain2 (0.8)Who suggested testing?Pediatrician196 (87.5)Parents13 (5.8)Dermatologist7 (3.1)Ophthalmologist3 (1.3)Rheumatologist2 (0.8)Other3 (1.3)Positivity of acute phase reactants15 (5.3)History of infection before testing56 (24.3)History of drug-using before testing39 (17)

Most of the diseases were diagnosed in patients with ANA positivity were not related with autoimmune mechanisms that associated with ANA positivity therefore, these diseases are thought to be coincidence. Only in 1 patients, systemic lupus erythematosus that has certain association with ANA positivity were diagnosed. All diseases that are diagnosed were shown in Table 2.

Table 2.

All diseases that are diagnosed in patients during the follow-up period.

n (%)Hypermobility Syndrome29 (10.2)Urticaria7 (2.4)Hypothyroidism6 (2.1)Transient synovitis4 (1.4)Chronic ITP*4 (1.4)Scoliosis4 (1.4)Familial Mediterranean Fever3 (1)Cryopyrin associated periodic Syndrome2 (0.7)PFAPA syndrome**2 (0.7)Celiac Disease2 (0.7)Acute Rheumatic Fever2 (0.7)Fibromyalgia1 (0.3)Bone Tumor1 (0.3)Juvenile Idiopathic Arthritis1 (0.3)Henoch-Shöenlein Purpura1 (0.3)Myastenia Graves1 (0.3)Sever Disease1 (0.3)Vitiligo1 (0.3)Systemic Lupus Erythematosus1 (0.3)

*Idiopathic Thrombocytopenic Purpura, **Periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis syndrome.

Conclusion:

We are reporting that in only 0.3% of patients with ANA positivity who don’t have any diseases diagnosed initially, were diagnosed as rheumatologic diseases during to the follow-up period. Since positivity of ANA is also common in the healthy population, requesting this test in only patients with high suspicion for connective tissue disease will reduce confusion in terms of diagnosis.

References:

[1]Kasapcopur O, Ozbakir F, Arisoy N, Ingol H, Yazici H, Ozdogan H. Frequency of antinuclear antibodies and rheumatoid factor in healthy Turkish children. Turk J Pediatr 1999;41:67-71.

Disclosure of Interests:

None declared

Assessment of the effectiveness of genital infection awareness training provided to women based on the IMB model

Background

Genital infections are one of the most common reasons for a hospital visit in the scope of reproductive health problems. The information-motivation-behavioral skills (IMB), therefore, is an appropriate model to provide women with accurate genital hygiene behaviors and develop effective sexual and reproductive health training programs.

Aims

This interventional study was conducted to assess the effectiveness of genital infection awareness training provided to women based on the IMB model.

Materials and Methods

Study sample consisted of 62 women (n_experimental= 31, n_control= 31) who were chosen based on a nonprobability sampling method from vocational courses of Ankara Keçiören municipality. The data collection form developed by the researchers, knowledge evaluation questions (KEQ), and genital hygiene behavior inventory (GHBI) were used to collect data. Data were obtained at training centers and through phone interviews. Another interview was conducted 1 month later and posttest procedures were completed. The Chi-square test, McNemar's, Mann-Whitney U test, and Wilcoxon Signed-Rank tests were used to calculate mean scores.

Results

The mean (SD) age was 39.1 (8.4) years for the women in the experimental group and 37.5 (6.7) for the women in the control group (P = 0.481). Pretest knowledge mean scores M (SD)_experimental = 15.7 (2.4); and GHBI mean scores M (SD)_experimental= 76.9 (11.1) were calculated. Mean scores showed an increase after the training in the experimental group [M (SD)_post-test= 19.1 (1.2); M (SD)_GHBI= 94.7 (2.6)] (P < 0.001).

Conclusion

Based on these findings, it was concluded that the genital infection awareness training provided to women based on the IMB model, improved knowledge and acted as a positive reinforcer for the hygiene behaviors of the women.

Duplication of the spleen accompanied by multiple anomalies of the thorax and abdomen: a rare case

Duplication of the spleen, classified as a polysplenia syndrome, is a very rare anomaly. Polysplenia is a complex syndrome with a broad spectrum of abnormalities. Other abnormalities accompanying polysplenia have been previously reported. In this paper, we present a case of duplication of the spleen accompanied by multiple anomalies in the thorax and abdomen.

Two Different Manifestations of Neonatal Vascular Injury: Dyke-Davidoff-Masson Syndrome and Crossed Cerebellar Atrophy

Dyke-Davidoff-Masson syndrome (DDMS) was first described in 1933 as a clinical condition characterized by hemiatrophy, hyperpneumatization of paranasal sinuses, contralateral hemiparesis, facial asymmetry, seizures, and mental retardation.¹ DDMS can be of 2 types: congenital and acquired. The congenital type can be caused by various conditions experienced during fetal or early childhood development, including ischemia, infarction, trauma, infections, and hemorrhage. The acquired type is mostly associated with hemorrhage, trauma, and infections experienced after 1 month of age. DDMS can manifest alone or can be accompanied by crossed cerebellar atrophy (CCA) which is a newly discovered radiological marker characterized by prominent cortical sulci and loss of cerebellar parenchyma. The congenital type of DDMS is known to be accompanied by ipsilateral cerebellar atrophy and the acquired type is known to be accompanied by contralateral cerebellar atrophy.^2,3 Supratentorial events may lead to destruction in the cortico-ponto-cerebellar pathways, mostly in the contralateral side of the body (80%) due to decussation.⁴ In this report, we present 2 cases of DDMS accompanied by CCA to emphasize the possibility that the DDMS cases with severe intrauterine hemorrhage can be accompanied by contralateral CCA and migratory abnormalities rather than ipsilateral CCA and clinical survey.

The effect of different treatment modalities on survival in elderly patients with locally advanced non-small cell lung cancer

PURPOSE

The aim of this study is to investigate the effect of treatment modalities on survival among unoperat ed and locally-advanced non-small cell lung cancer (NSCLC) patients aged 70 years and older, representing real-life data.

METHODS

From 2005 through 2017, medical records of 2259 patients with lung cancer from Okmeydani Training and Research Hospital-Istanbul/Turkey were reviewed retrospectively. Patients with locally advanced NSCLC ≥ 70 years of age who did not undergo surgery for lung cancer were reviewed. In total, 130 patients were eligible for the final analysis. Patients were stratified into four groups as: chemotherapy (CT), concurrent chemoradiotherapy (cCRT), sequential chemoradiotherapy (sCRT), and radiotherapy (RT) only.

RESULTS

Of the 130 patients included in the analysis; CT, cCRT, sCRT, and RT only were applied to 25(19.2%), 30(23.1%), 31(23.8%), and 44(33.8%) patients, retrospectively. Twelve (9.2%) patients were female. Median age was 72 years (range, 70-88). Sixty (46.2%) patients had stage IIIA disease and 70(53.8%) patients had stage IIIB disease. Median progression-free survival(mPFS) in patients treated with CT, cCRT, sCRT, and RT were 8.0, 15, 10, and 9.0 months, respectively(p = 0.07). Corresponding median overall survival (mOS) were 10, 33, 20, and 15 months (p = 0.04). In multivariate analysis, stage IIIB disease [hazard ratio (HR), 2.8], ECOG-PS 2(HR, 2.10), and ECOG-PS 3-4(HR, 5.13) were found to be the negative factors affecting survival, while cCRT (HR, 0.45) and sCRT (HR, 0.50) were the independent factors associated with better survival.

CONCLUSION

This study showed that the use of combined treatment modality was associated with better survival in elderly patients with locally advanced NSCLC, with the greatest survival observed in patients treated with cCRT. We therefore suggest that cCRT, when feasible, should be strongly considered in locally advanced NSCLC patients 70 years and over.

RELIABILITY OF THE CORTICOTROPIN RELEASING HORMONE STIMULATION TEST FOR DIFFERENTIATING BETWEEN ACTH DEPENDENT AND INDEPENDENT CUSHING SYNDROME

Context

It is a challenge to determine the origin of Cushing syndrome (CS), especially in patients with low-normal adrenocorticotropic hormone (ACTH) concentrations.

Objective

To evaluate the reliability of the corticotropin-releasing hormone (CRH) stimulation test in patients with CS whose origin of disease was not clearly identified using ACTH values, the high-dose dexamethasone suppression test (HDDST), and imaging in a single tertiary referral center.

Design and Methods

Twenty-one patients with CS who were admitted to the endocrinology-metabolism clinic between 2004 and 2016 whose ACTH concentrations were 5-20 pg/mL and needed CRH stimulation test were retrospectively assessed.

Results

Nine out of 21 patients were diagnosed as having Cushing's disease (CD) and 12/21 had adrenal CS. The CRH stimulation test had a sensitivity and specificity of 100% and 8%, and positive and negative predictive values of 100% and 45% according to the current diagnostic criteria, respectively. An increase in ACTH ≥115% at 15 minutes and cortisol ≥86% at 60 minutes after CRH were associated with the highest likelihood ratio. The sensitivity and specificity of ACTH was 67% and 83% (AUC=0.75±0.12, 95% CI: [0.5-0.9]; p=0.03), and for cortisol it was 75% and 78% (AUC=0.71±0.15, 95% CI: [0.5-0.9]; p=0.03). Cortisol suppression of more than 64% from basal level in the HDDST suggested CD with the highest likelihood ratio. When these cut-off values were used together, both tests were negative in the patients with CD.

Conclusion

The CRH stimulation test has low specificity to localize CS in patients with ACTH concentrations of 5-20 pg/mL according to the current diagnostic criteria. Different diagnostic criteria may be used in the CRH stimulation test and also in the HDDST in this group of patients.

Protective effect of nebivolol on gentamicin-induced nephrotoxicity in rats

OBJECTIVE

Nephrotoxicity is a major complication of gentamicin (GEN), which is widely used in the treatment of severe Gram-negative infections. As we know, treatment with nebivolol has been shown to decrease renal fibrosis and glomerular injury as well as improve endothelial dysfunction. Therefore, we evaluated the potential protective effect of nebivolol (NBV) against GEN-induced nephrotoxicity in rats.

MATERIAL AND METHOD

Twenty-four rats were randomly divided into four groups: control group (Group 1); rats intraperitoneally injected with GEN (100 mg/kg/day; Group 2); rats treated with GEN plus distilled water (Group 3); and rats treated with GEN plus NBV (10 mg/kg/day; Group 4). After 15 days, the rats were sacrificed, their kidneys taken, and blood analysis performed. Tubular necrosis and interstitial fibrosis scores were determined histopathologically in a part of kidneys; nitric oxide (NO), malondialdehyde (MDA), and reduced glutathione (GSH) levels were determined in other part of kidneys.

RESULTS

The GSH levels in renal tissue of only GEN-treated rats were significantly lower than those in control group, and administration of NBV to GEN-treated rats significantly increased the level of GSH. The group that was given GEN and NBV had significantly lower MDA and NO levels in kidney cortex tissue than that given GEN alone. Despite the presence of mild tubular degeneration, the rats treated with GEN+NBV showed a less severe tubular necrosis, and their glomeruli maintained a better morphology compared to GEN group.

CONCLUSION

NBV exerts antioxidant, anti-inflammatory and antifibrotic effects on GEN-induced kidney damage by reducing oxidative stress in rat model (Tab. 3, Fig. 2, Ref. 68).

Hepatitis A virus vaccination in childhood-onset systemic lupus erythematosus

Objectives: Vaccination of systemic lupus erythematosus patients with non-live vaccines may decrease vaccine-preventable infections and mortalities. In the present study, we aimed to compare the immunogenicity and safety of inactivated hepatitis A vaccination in childhood-onset systemic lupus erythematosus and healthy subjects. Methods: A total of 30 childhood-onset systemic lupus erythematosus and 39 healthy participants who were seronegative for hepatitis A received two doses of the hepatitis A vaccine in a 0- and 6-month schedule. Hepatitis A virus (HAV) IgG antibodies were measured before vaccination and 7 months after the vaccination. Results: Although anti-HAV IgG antibody titers after vaccination were found to be somewhat lower in children with systemic lupus erythematosus than that of the healthy subjects ( p < 0.05), the difference in seroconversion rate was insignificant between childhood-onset systemic lupus erythematosus patients ( n = 24/30, 80%) and healthy controls ( n = 33/39, 84.6%). There was no increase in median Systemic Lupus Erythematosus Disease Activity Index (SLEDAI)-2K scores and anti-ds DNA levels after the vaccination procedure. Seroconversion rates in childhood-onset systemic lupus erythematosus patients were not affected by medication, high disease activity (SLEDAI-2K >6) and anti-ds DNA positivity. None of the patients experienced any flare or adverse reaction throughout the study. Conclusions: According to these results, we conclude that inactivated hepatitis A vaccine is safe and well tolerated in childhood-onset systemic lupus erythematosus patients, with no adverse events or increase in activity. Immunogenicity to the hepatitis A vaccine was adequate, with a seropositivity rate of 80%.

High serum levels of IGF-I and IGFBP3 may increase comorbidity risk for asthmatic patients

OBJECTIVE

Asthma is known as a chronic inflammatory lung disease which has also systemic features. Insulin-like growth factor I (IGF-I) plays a role for asthma pathogenesis. Controversially, IGF-binding protein 3 (IGFBP3) blocks asthma development. That is why IGF-I and IGFBP3 are targeted for future therapeutic treatments of asthma. We aimed to investigate serum level of IGF-I and IGFBP3 in patients with asthma. This study was performed in 27 asthma and 23 healthy individuals. Serum levels of IGF-I and IGFBP3 were measured by human ELISA assay kits. Serum levels of IGF-I and IGFBP3 were significanlty higher in the asthma group than the control group. Significant negative correlation was found between IGF-I and asthma control test (ACT) puan, O2 saturation, Forced Expiratory Volume in 1 second/ Forced Vital Capacity (FEV1/FVC), Forced Expiratory Flow 25 second/75 second (FEF2575) (%). Significant positive correlation was found between IGFBP3 and IGF-I, systolic blood pressure. Significant negative correlation was found between IGF-I and FEV1 (ml).

RESULTS

Our results indicate that the serum levels of IGF-I and IGFBP3 are significanlty elevated in the asthma group. We assume that current treatment strategies are not really good enough for asthma. We suppose further strategies which are seeking to balance IGF-I and IGFBP3 should be developed for more effective and curative treatment of asthma (Tab. 2, Fig. 2, Ref. 22).