Evaluation of the retina, choroid and optic disc vascular structures in individuals with a history of COVID-19

INTRODUCTION

In this study, we aimed to detect changes in posterior segment structures and vascular density caused by COVID-19 using an optical coherence tomography angiography (OCTA) device.

MATERIALS AND METHODS

The study included 20 eyes of 20 patients no systemic or ocular disease who were followed at the Ophthalmology Clinic of Health Sciences University Antalya Training and Research Hospital. The OCTA images of these individuals taken prior to contracting COVID-19 and six months after recovery were examined.

RESULTS

The mean choriocapillaris blood flow was 2.00±0.13mm2 before COVID-19 and 2.08±0.23mm2 after the disease, and the mean subfoveal choroidal thickness was 247.33±7.65μm before the disease and 273.08±4.92μm after the disease, indicating a statistically significant difference (P=0.003, P=0.001, respectively). The mean retinal nerve fiber layer thickness before and after COVID-19 were 119.33±3.88 and 117.50±3.92μm, respectively, representing a statistically significant decrease (P<0.001).

CONCLUSION

This is the first study in the literature to evaluate the post-COVID-19 changes in the vascular structures of the eye compared to the pre-disease values. In this study, we found statistically significant changes in choriocapillaris blood flow, subfoveal chroidal thickness and retinal nerve fiber layer thickness after COVID-19 infection. Further research with a greater sample size is needed to explore the effect of COVID-19 on these parameters.

Identified Factors in COVID-19 Patients in Predicting Mortality

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has led to a significant increase in global mortality rates. Numerous studies have been conducted to identify the factors associated with mortality in COVID-19 cases. In these studies, overall mortality was evaluated in patients, and no distinction was made as ward or intensive care mortality.

AIM

This study aims to determine mortality-related factors in patients who died while in the ward. This could enable us to review the indications for intensive care hospitalization in possible pandemics.

MATERIALS AND METHOD

This retrospective study was conducted on a cohort of 237 patients who applied to our institution between January 2020 and December 2021 with the diagnosis of COVID-19. Demographic characteristics, length of stay, type of admission (emergency ward or outpatient clinic), presence of comorbidities, thoracic computerized tomography (CT) findings, and laboratory findings were extracted from the hospital database. The demographic and laboratory results of both deceased and recovered patients were compared.

RESULTS

While many demographic and laboratory findings were statistically significant in the initial analysis, multiple logistic regression analysis showed that decreased albumin levels (adjusted OR = 0.23, 95% CI = 0.09 - 0.57), increased troponin (adjusted OR = 1.03, 95% CI = 1.02 - 1.05), and procalcitonin (adjusted OR = 3.46, 95% CI = 1.04 - 11.47) levels and higher partial thromboplastin time (PTT) (adjusted OR = 1.18, 95% CI = 1.09 - 1.28) values, presence of diabetes mellitus (DM) in patients (adjusted OR = 2.18, 95% CI = 1.01 - 4.69, P = 0.047), and admission to hospital from the emergency department (adjusted OR = 5.15, 95% CI = 1.45 - 18.27, P = 0.011) were significantly associated with mortality when adjusted for age. When a predictive model is constructed with these variables, this model predicted mortality statistically significant (AUC = 0.904, 95% CI = 0.856 - 0.938, P < 0.001), with a sensitivity of 77.2% (95% CI, 67.8 - 85), a specificity of 91.2% (95% CI, 85.1 - 95.4), a positive predictive value (PPV) of 86.7% (95% CI, 72 - 85.3), and an negative predictive value (NPV) of 84.4% (95% CI, 79.4 - 89.6).

CONCLUSION

In this study, we may predict mortality among COVID-19-diagnosed patients admitted to the ward via this model which has the potential to provide guidance for reconsidering the indications for intensive care unit (ICU) admission.

The Effect of the Method of Downhole Deployment on Distributed Acoustic Sensor Measurements: Field Experiments and Numerical Simulations

Distributed acoustic sensing (DAS) is a promising technology for seismic data acquisition, particularly in downhole applications. However, downhole DAS measurements can be affected by the deployment method of the fibre-optic cable. These effects were explored in a field trial in two wells (one vertical and one deviated) drilled at the Otway International Test Centre. The trial in the vertical well shows that (1) fibre-optic cables cemented behind the casing provide data of the highest quality due to the best coupling to the formation, and (2) tubing-conveyed cable shows only slightly weaker coupling, but the data quality can be severely degraded by source-generated noise. A cable loosely suspended in the deviated well provided data quality comparable to that of the cemented DAS cable. To better understand the nature of the observed effects, the field experiments were supplemented by numerical modelling with a 1.5D full wave reflectivity algorithm (3D wave propagation in a 1D model), where cement, casing and wellbore were represented by infinite vertical layers. The results show that (1) a cement layer has only a slight effect (<5%) on the DAS amplitude; (2) the vertical strain in a liquid-filled borehole is comparable to that in the formation; and (3) the strain amplitude in the cable is of the same order of magnitude both in the formation and in the fluid. The strain in the cable is zero both when the cable's Poisson's ratio is zero and when the borehole fluid is air. The results confirm the feasibility of borehole DAS measurements with fibre-optic cables suspended in a borehole liquid (but not gas!).

A rare case of pediatric ptosis: Coexistence of giant intracranial arachnoid cyst and facial asymmetry

BACKGROUND

Intracranial arachnoid cysts are cystic congenital malformations, filled with cerebrospinal fluid (CSF) originating from the arachnoid membrane. Generally, giant arachnoid cysts present with symptoms related to increased intracranial pressure, hydrocephalus or cognitive disorders, endocrinological problems, growth retardation, seizures, headache, and nonspecific symptoms such as dizziness. They can be detected by imaging when they become symptomatic or incidentally in childhood and adulthood. Our case was referred to our clinic because of ptosis and facial asymmetry found on examination. Subsequently, a intracranial giant arachnoid cyst was found incidentally on cranial computed tomography (CT).

CASE

In an 18-month-old male infant admitted with ptosis, left frontal bulging and a dystopic globe with ptosis of the left upper lid were noted. The left half of the facial region and the left nostril also appeared to be asymmetrically elongated downward relative to the right. Fundus examination revealed an optic disc coloboma in the left eye. On general physical examination, he was unable to walk. A giant fronto-temporo-parietal arachnoid cyst with the cerebral parenchyma shifted 2cm to the right of the midline was observed on cranial CT. After a cysto-peritoneal shunt was performed, the physical appearance of our patient returned to normal.

CONCLUSION

Ptosis cases accompanied by abnormalities such as optic disc coloboma and facial asymmetry should be evaluated for possible midline defects and intracranial pathologies prior to eyelid surgery.

Evidence of Nonlinear Seismic Effects in the Earth from Downhole Distributed Acoustic Sensors

Seismic velocities and elastic moduli of rocks are known to vary significantly with applied stress, which indicates that these materials exhibit nonlinear elasticity. Monochromatic waves in nonlinear elastic media are known to generate higher harmonics and combinational frequencies. Such effects have the potential to be used for broadening the frequency band of seismic sources, characterization of the subsurface, and safety monitoring of civil engineering infrastructure. However, knowledge on nonlinear seismic effects is still scarce, which impedes the development of their practical applications. To explore the potential of nonlinear seismology, we performed three experiments: two in the field and one in the laboratory. The first field experiment used two vibroseis sources generating signals with two different monochromatic frequencies. The second field experiment used a surface orbital vibrator with two eccentric motors working at different frequencies. In both experiments, the generated wavefield was recorded in a borehole using a fiber-optic distributed acoustic sensing cable. Both experiments showed combinational frequencies, harmonics, and other intermodulation products of the fundamental frequencies both on the surface and at depth. Laboratory experiments replicated the setup of the field test with vibroseis sources and showed similar nonlinear combinations of fundamental frequencies. Amplitudes of the nonlinear signals observed in the laboratory showed variation with the saturating fluid. These results confirm that nonlinear components of the wavefield propagate as body waves, are likely to generate within rock formations, and can be potentially used for reservoir fluid characterization.

Monitoring Injected CO2 Using Earthquake Waves Measured by Downhole Fibre-Optic Sensors: CO2CRC Otway Stage 3 Case Study

Monitoring changes of formation properties along the well bore associated with the presence of carbon dioxide can be important for both tracking the plume inside of the primary containment and detecting leakage into the zone located above the reservoir. This can be achieved with time lapse wireline logging, but this approach requires well intervention and is not always possible. If the well is permanently instrumented with an optical fibre, it can be used as a distributed seismic receiver array to detect gas behind the casing by monitoring changes in amplitude of the seismic waves generated by active or passive seismic sources. Previous research showed the efficacy of this technique using continuous seismic sources. The Stage 3 Otway Project presented an opportunity to test this technique using passive seismic recording, as downhole fibre-optic arrays recorded numerous regional earthquakes over the period of nearly 2 years before, during, and after CO₂ injection. Analysis of P-wave amplitudes extracted from these downhole gathers shows a consistent amplitude anomaly at the injection level, visible in all events that occurred after the start of injection. This indicates that the anomaly is caused by changes in elastic properties in the reservoir caused by CO₂ saturation. However, extracted amplitudes show significant variability between earthquakes even without subsurface changes; thus, multiple events are required to distinguish the time-lapse anomaly from time-lapse noise. Ubiquity of these events even in a tectonically quiet region (such as Australia) makes this technique a viable and cost-effective option for downhole monitoring.

Prognostic significance of N-Terminal Pro-BNP in patients with COVID-19 pneumonia without previous history of heart failure

Introduction

The objective of the present research was to evaluate the possible association between the N-terminal pro-brain type natriuretic peptide (NT-proBNP) levels and in-hospital mortality in coronavirus disease 2019 (COVID-19) pneumonia patients who did not have pre-existing heart failure (HF).

Methods

A total of 137 consecutive patients without pre-existing HF and hospitalized due to COVID-19 pneumonia were enrolled into the current research. The main outcome of the research was the in-hospital death. The independent parameters linked with the in-hospital death were determined by multivariable analysis.

Results

A total of 26 deaths with an in-hospital mortality rate of 18.9% was noted. Those who died were older with an increased frequency of co-morbidities such as hypertension, chronic kidney disease, coronary artery disease, stroke and dementia. They had also increased white blood cell (WBC) counts and had elevated glucose, creatinine, troponin I, and NT-pro-BNP levels but had decreased levels of hemoglobin. By multivariable analysis; age, NT-pro-BNP, WBC, troponin I, and creatinine levels were independently linked with the in-hospital mortality. After ROC evaluation, the ideal value of the NT-pro-BNP to predict the in-hospital mortality was found as 260 ng/L reflecting a sensitivity of 82% and a specificity of 93% (AUC:0.86; 95% CI: 0.76–0.97).

Conclusion

The current research clearly shows that the NT-proBNP levels are independently linked with the in-hospital mortality rates in subjects with COVID-19 pneumonia and without HF. Thus, we believe that this biomarker can be used as a valuable prognostic parameter in such cases.

Funding Acknowledgement

Type of funding sources: None. Figure 1

Investigating the efficacy and safety of oral spironolactone in patients with central serous chorioretinopathy

OBJECTıVE: The goal of this study was to investigate the efficacy and safety of oral spironolactone in patients with central serous chorioretinopathy (CSC). MATERıALS AND METHODS: In our study, acute CSC patients were divided into two groups: those who received spironolactone 25mg twice a day as the study group, and those who were not treated as the control group. Fundus fluorescein angiography was performed in all patients. Subretinal fluid (SRF) height and central macular thickness (CMT) spectral area were measured by optical coherence tomography as well as subfoveal choroid thickness (CT) in enhanced depth imaging (EDI) mode. The best-corrected visual acuity (BVCA) was measured with the Snellen chart. Side effects of spironolactone were evaluated. RESULTS: There were 31 eyes in the study group and 28 eyes in the control group. The mean follow-up was 2.4±0.5 months. The average SRF height of 240.26±92.89μm in the study group decreased to 26.77±39.52μm (P<0.05) at the last follow-up. SRF height was completely improved in 18 eyes (58.06%). On the first evaluation, the mean CMT of 453.26±147.73 was reduced to 276.19±109.29μm at the last follow-up. (P<0.05). While the initial mean subfoveal CT was 482.10±86.36μm, it decreased to 427.10±83.32μm at the last follow-up (P<0.01). The mean baseline BCVA of 0.5±0.23 was increased to 0.9±0.16 (P<0.01) at the last follow-up. At the last follow-up, BCVA was 10/10 (1.0) in 21 eyes (67.74%). In the control group, the mean SRF height of 277.71±108.83μm was 172.96±93.88μm (P<0.05) at the last follow-up. The mean CMT in the control group was 464.5±131.14μm at the first evaluation and 349.82±111.45μm (P<0.05) at the last follow-up. The initial mean subfoveal CT was 487.93±88.9μm; at the last follow-up, it was 447.71±71.32μm (P<0.01). While the mean BCVA of the control group was initially 0.53±0.19, it was found to be 0.64±0.19 (P<0.01) at the final control. The decrease in SRF height in the 3rd month was significantly greater in the study group compared to the control group (P<0.01). However, the decrease in CMT at 3 months and an increase in BCVA were also significant in the study group compared to the control group (P<0.01). CT decreased significantly in the third month in both groups compared to the first month, but there was no difference between the two groups. In a patient who developed palpitations and nausea, treatment was discontinued because he could not tolerate oral spironolactone. CONCLUSıON: In our series, effective visual improvement and subretinal fluid resorption were achieved in acute CSC patients who were given spironolactone. Side effects are rare.

THU0271 PERFORMANCE OF THE EULAR/ACR 2019 CLASSIFICATION CRITERIA FOR SYSTEMIC LUPUS ERYTHEMATOSUS IN EARLY DISEASE, ACROSS SEXES AND ETHNICITIES

Background:

EULAR/ACR 2019 SLE Classification Criteria were validated in an international cohort.

Objectives:

To evaluate performance characteristics of SLE classification systems in sex, race/ethnicity, and disease duration subsets.

Methods:

Sensitivity and specificity of the EULAR/ACR 2019, SLICC 2012 and ACR 1982/1997 criteria were evaluated in the validation cohort.

Results:

The cohort consisted of female (n=1098), male (n=172), Asian (n=118), Black (n=68), Hispanic (n=124) and White (n=941) patients; and patients with an SLE duration of 1-3 years (n=196), 3-5 years (n=157), and ≥5 years (n=879). Among patients with 1-3 years disease duration, the EULAR/ACR criteria had better sensitivity than the ACR criteria (97% (95%CI 92-99%) vs 81% (95%CI 72-88%). The new criteria performed well in men (sensitivity 93%, specificity 96%) and women (sensitivity 97%, specificity 94%). The new criteria had better sensitivity than the ACR criteria in White (95% vs 83%), Hispanic (100% vs 86%) and Asian patients (97% vs 77%).

Conclusion:

The EULAR/ACR 2019 criteria perform well in patients with early disease, and across sexes and ethnicities.

Disclosure of Interests:

Sindhu Johnson Grant/research support from: Boehringer Ingelheim, Corbus Pharmaceuticals, GlaxoSmithKline, Roche, Merck, Bayer, Consultant of: Boehringer Ingelheim, Ikaria, Ralph Brinks: None declared, Karen Costenbader Grant/research support from: Merck, Consultant of: Astra-Zeneca, David Daikh: None declared, Marta Mosca: None declared, Rosalind Ramsey-Goldman: None declared, Josef S. Smolen Grant/research support from: AbbVie, Eli Lilly, Janssen, Merck Sharp & Dohme, Pfizer, Roche – grant/research support, Consultant of: AbbVie, Amgen Inc., AstraZeneca, Astro, Celgene Corporation, Celtrion, Eli Lilly, Glaxo, ILTOO, Janssen, Medimmune, Merck Sharp & Dohme, Novartis, Pfizer, Roche, Samsung, Sanofi, UCB – consultant, Speakers bureau: AbbVie, Amgen Inc., AstraZeneca, Astro, Celgene Corporation, Celtrion, Eli Lilly, Glaxo, ILTOO, Janssen, Medimmune, Merck Sharp & Dohme, Novartis, Pfizer, Roche, Samsung, Sanofi, UCB – speaker, David Wofsy: None declared, Dimitrios Boumpas Grant/research support from: Unrestricted grant support from various pharmaceutical companies, Diane L Kamen Consultant of: Consulted on SLE survey development for Lilly and consulted on SLE trial protocol development for EMD Serono in 2019, David Jayne Grant/research support from: ChemoCentryx, GSK, Roche/Genentech, Sanofi-Genzyme, Consultant of: Astra-Zeneca, ChemoCentryx, GSK, InflaRx, Takeda, Insmed, Chugai, Boehringer-Ingelheim, Ricard Cervera: None declared, Nathalie Costedoat-Chalumeau Grant/research support from: UCB to my institution, Betty Diamond: None declared, Dafna D Gladman Grant/research support from: AbbVie, Amgen Inc., BMS, Celgene Corporation, Janssen, Novartis, Pfizer, UCB – grant/research support, Consultant of: AbbVie, Amgen Inc., BMS, Celgene Corporation, Janssen, Novartis, Pfizer, UCB – consultant, Bevra H. Hahn Grant/research support from: Janssen Research & Development, LLC, Falk Hiepe: None declared, Soren Jacobsen: None declared, Dinesh Khanna Shareholder of: Eicos Sciences, Inc./Civi Biopharma, Inc., Grant/research support from: Dr Khanna was supported by NIH/NIAMS K24AR063120, Consultant of: Acceleron, Actelion, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Corbus Pharmaceuticals, Horizon Therapeutic, Galapagos, Roche/Genentech, GlaxoSmithKline, Mitsubishi Tanabe, Sanofi-Aventis/Genzyme, UCB, Kirsten Lerstrom: None declared, Elena Massarotti: None declared, William Joseph McCune: None declared, Guillermo Ruiz-Irastorza: None declared, Jorge Sanchez-Guerrero: None declared, Matthias Schneider: None declared, Murray B Urowitz: None declared, George Bertsias Grant/research support from: GSK, Consultant of: Novartis, Bimba F. Hoyer: None declared, Nicolai Leuchten: None declared, Chiara Tani: None declared, Sara Tedeschi: None declared, Zahi Touma: None declared, Gabriela Schmajuk Grant/research support from: Pfizer, Branimir Anic: None declared, Florence Assan: None declared, Tak Chan: None declared, Ann E Clarke: None declared, Mary K. Crow: None declared, László Czirják Consultant of: Actelion, BI, Roche-Genentech, Lilly, Medac, Novartis, Pfizer, Bayer AG, Andrea Doria Consultant of: GSK, Pfizer, Abbvie, Novartis, Ely Lilly, Speakers bureau: UCB pharma, GSK, Pfizer, Janssen, Abbvie, Novartis, Ely Lilly, BMS, Winfried Graninger: None declared, Bernadett Halda-Kiss: None declared, Sarfaraz Hasni: None declared, Peter Izmirly: None declared, Michelle Jung: None declared, Gabor Kumanovics Consultant of: Boehringer, Teva, Speakers bureau: Roche, Lilly, Novartis, Xavier Mariette: None declared, Ivan Padjen: None declared, Jose M Pego-Reigosa: None declared, Juanita Romero-Diaz Consultant of: Biogen, Iñigo Rua-Figueroa: None declared, Raphaèle Seror Consultant of: BMS, Medimmune, Novartis, Pfizer, GSK, Lilly, Georg Stummvoll: None declared, Yoshiya Tanaka Grant/research support from: Asahi-kasei, Astellas, Mitsubishi-Tanabe, Chugai, Takeda, Sanofi, Bristol-Myers, UCB, Daiichi-Sankyo, Eisai, Pfizer, and Ono, Consultant of: Abbvie, Astellas, Bristol-Myers Squibb, Eli Lilly, Pfizer, Speakers bureau: Daiichi-Sankyo, Astellas, Chugai, Eli Lilly, Pfizer, AbbVie, YL Biologics, Bristol-Myers, Takeda, Mitsubishi-Tanabe, Novartis, Eisai, Janssen, Sanofi, UCB, and Teijin, Maria Tektonidou Grant/research support from: AbbVie, MSD, Novartis and Pfizer, Consultant of: AbbVie, MSD, Novartis and Pfizer, Carlos Vasconcelos: None declared, Edward Vital Grant/research support from: AstraZeneca, Roche/Genentech, and Sandoz, Consultant of: AstraZeneca, GSK, Roche/Genentech, and Sandoz, Speakers bureau: Becton Dickinson and GSK, Daniel J Wallace: None declared, Sule Yavuz: None declared, Pier Luigi Meroni: None declared, Marvin Fritzler: None declared, Raymond Naden: None declared, Thomas Dörner Grant/research support from: Janssen, Novartis, Roche, UCB, Consultant of: Abbvie, Celgene, Eli Lilly, Roche, Janssen, EMD, Speakers bureau: Eli Lilly, Roche, Samsung, Janssen, Martin Aringer Consultant of: Boehringer Ingelheim, Roche, Speakers bureau: Boehringer Ingelheim, Roche

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

Relationship between red cell distribution width and mean platelet volume with new onset atrial fibrillation afteroff-pump coronary artery bypass grafting

OBJECTIVE

The aim of this study was to evaluate the relationship between red blood cell distribution width (RDW) and mean platelet volume (MPV) with development of postoperative atrial fibrillation (PoAF) after off-pump coronary artery bypass grafting (CABG).

BACKGROUND

The RDW and MPV have been associated with some cardiovascular disorders.

METHODS

A total of 93 patients who underwent off-pump CABG were included in this study. The patients were divided into two groups as developing and nondeveloping PoAF groups in the postoperative period. We measured whether RDW and MPV levels are a predictive value for development PoAF.

RESULTS

There were 24 patients with PoAF enrolled (mean age: 66 ± 7.8 years) and 69 patients without PoAF (mean age: 56.26 ± 11.53 years). The PoAF was significantly correlated with age (p = 0.004), hematocrit (p: 0.010), RDW (p = 0.007) and creatinine (p = 0.006). Only advanced age (p = 0.012) was identified as an independent predictor of PoAF. For predicting PoAF, there was 79.2 % sensitivity and 65.2 % specificity for RDW (p = 0.001) and 62.5 % sensitivity and 55.1 % specificity for MPV (p = 0.062).

CONCLUSIONS

We found that RDW levels and MPV were not an independent predictor of the development of PoAF. However, elevated RDW levels and MPV may be one of the predictive values for PoAF development (Tab. 3, Fig. 2, Ref. 27).

Glucose pump test can be used to measure blood flow rate of native arteriovenous fistula in chronic hemodialysis

PURPOSE

In chronic hemodialysis patients, the low flow of vascular access may leads to inadequate dialysis, increased rate of hospitalization, morbidity, and mortality. It was found that surveillance should be performed for native arteriovenous (AV) should not be performed for AV graft in various studies. However, surveillance was done in graft AV fistulas in most studies. Doppler ultrasonography (US) was suggested for surveillance of AV fistulas by the last vascular access guideline of National Kidney Foundation Disease Outcomes Quality Initiative (NKF KDOQI). The aim of study is to determine whether glucose pump test (GPT) is used for surveillance of native AV fistulas by using Doppler US as reference.

METHODS

In 93 chronic hemodialysis patients with native AV fistula, blood flow rates were measured by Doppler US and GPT. For GPT, glucose was infused to 16 mL/min by pump and was measured at basal before the infusion and 11 s after the start of the infusion by glucometer. Doppler US was done by an expert radiologist. Used statistical tests were Mann-Whitney U test, Friedman test, regression analysis, and multiple regression analysis.

RESULTS

Median values of blood flow rates measured by GPT (707 mL/min) and by Doppler US (700 mL/min) were not different (Z = 0.414, P = 0.678). Results of GPT and Doppler US measurements were positive correlate by regression analysis. The mean GPT value of diabetic patients (n = 39; 908 mL/min) was similar to that of nondiabetic patients (n = 54; 751 mL/min; Z = 1.31, P = 0.188). GPT values measured at three different dialysis session did not differ from each other that by Friedman test (F = 0.92, P = 0.39). This showed that GPT was stable and reliable.

CONCLUSIONS

Glucose pump test can be used to measure blood flow rate of native AV fistula. GPT is an accurate and reliable test.

EULAR recommendations for women's health and the management of family planning, assisted reproduction, pregnancy and menopause in patients with systemic lupus erythematosus and/or antiphospholipid syndrome

Objectives

Develop recommendations for women's health issues and family planning in systemic lupus erythematosus (SLE) and/or antiphospholipid syndrome (APS).

Methods

Systematic review of evidence followed by modified Delphi method to compile questions, elicit expert opinions and reach consensus.

Results

Family planning should be discussed as early as possible after diagnosis. Most women can have successful pregnancies and measures can be taken to reduce the risks of adverse maternal or fetal outcomes. Risk stratification includes disease activity, autoantibody profile, previous vascular and pregnancy morbidity, hypertension and the use of drugs (emphasis on benefits from hydroxychloroquine and antiplatelets/anticoagulants). Hormonal contraception and menopause replacement therapy can be used in patients with stable/inactive disease and low risk of thrombosis. Fertility preservation with gonadotropin-releasing hormone analogues should be considered prior to the use of alkylating agents. Assisted reproduction techniques can be safely used in patients with stable/inactive disease; patients with positive antiphospholipid antibodies/APS should receive anticoagulation and/or low-dose aspirin. Assessment of disease activity, renal function and serological markers is important for diagnosing disease flares and monitoring for obstetrical adverse outcomes. Fetal monitoring includes Doppler ultrasonography and fetal biometry, particularly in the third trimester, to screen for placental insufficiency and small for gestational age fetuses. Screening for gynaecological malignancies is similar to the general population, with increased vigilance for cervical premalignant lesions if exposed to immunosuppressive drugs. Human papillomavirus immunisation can be used in women with stable/inactive disease.

Conclusions

Recommendations for women's health issues in SLE and/or APS were developed using an evidence-based approach followed by expert consensus.

Protective Antioxidant Effects of Carvedilol in a Rat Model of Ischaemia-reperfusion Injury

This study investigated the protective effects of carvedilol, a potent antioxidant, in a rat model of tourniquet-induced ischaemia-reperfusion injury of the hind limb. Thirty rats were divided equally into three groups: the control group (group 1) was only anaesthetized, without creating an ischaemia-reperfusion injury; group 2 was submitted to ischaemia (4 h), followed by a 2-h reperfusion period; and group 3 was pre-treated with carvedilol (2 mg/kg per day) for 10 days prior to ischaemia-reperfusion. Ischaemia-reperfusion produced a significant decrease in superoxide dismutase and glutathione peroxidase activities in the liver, lungs, muscle and serum compared with control treatment, and pre-treatment with carvedilol prevented these changes. Ischaemia-reperfusion caused a significant increase in malondialdehyde and nitric oxide (NO) levels in liver, lungs, muscle (except NO) and serum compared with control treatment, and carvedilol prevented these changes. In conclusion, it might be inferred that carvedilol could be used safely to prevent oxidative injury during reperfusion following ischaemia in humans.

Graphene oxide as a p-dopant and an anti-reflection coating layer, in graphene/silicon solar cells

It is shown that coating graphene-silicon (Gr/Si) Schottky junction based solar cells with graphene oxide (GO) improves the power conversion efficiency (PCE) of the cells, while demonstrating unprecedented device stability. The PCE has been shown to be increased to 10.6% (at incident radiation of 100 mW cm(-2)) for the Gr/Si solar cell with an optimal GO coating thickness compared to 3.6% for a bare/uncoated Gr/Si solar cell. The p-doping of graphene by the GO, which also serves as an antireflection coating (ARC) has been shown to be a main contributing factor to the enhanced PCE. A simple spin coating process has been used to apply GO with thickness commensurate with an anti-refection coating (ARC) and indicates the suitability of the developed methodology for large-scale solar cell assembly.

Proposed diagnostic algorithm for patients with suspected mastocytosis: a proposal of the European Competence Network on Mastocytosis

Mastocytosis is an emerging differential diagnosis in patients with more or less specific mediator-related symptoms. In some of these patients, typical skin lesions are found and the diagnosis of mastocytosis can be established. In other cases, however, skin lesions are absent, which represents a diagnostic challenge. In the light of this unmet need, we developed a diagnostic algorithm for patients with suspected mastocytosis. In adult patients with typical lesions of mastocytosis in the skin, a bone marrow (BM) biopsy should be considered, regardless of the basal serum tryptase concentration. In adults without skin lesions who suffer from mediator-related or other typical symptoms, the basal tryptase level is an important parameter. In those with a slightly increased tryptase level, additional investigations, including a sensitive KIT mutation analysis of blood leucocytes or measurement of urinary histamine metabolites, may be helpful. In adult patients in whom (i) KIT D816V is detected and/or (ii) the basal serum tryptase level is clearly increased (>25-30 ng/ml) and/or (iii) other clinical or laboratory features suggest the presence of 'occult' mastocytosis or another haematologic neoplasm, a BM investigation is recommended. In the absence of KIT D816V and other signs or symptoms of mastocytosis or another haematopoietic disease, no BM investigation is required, but the clinical course and tryptase levels are monitored in the follow-up. In paediatric patients, a BM investigation is usually not required, even if the tryptase level is increased. Although validation is required, it can be expected that the algorithm proposed herein will facilitate the management of patients with suspected mastocytosis and help avoid unnecessary referrals and investigations.

Refined diagnostic criteria and classification of mast cell leukemia (MCL) and myelomastocytic leukemia (MML): a consensus proposal

Mast cell leukemia (MCL), the leukemic manifestation of systemic mastocytosis (SM), is characterized by leukemic expansion of immature mast cells (MCs) in the bone marrow (BM) and other internal organs; and a poor prognosis. In a subset of patients, circulating MCs are detectable. A major differential diagnosis to MCL is myelomastocytic leukemia (MML). Although criteria for both MCL and MML have been published, several questions remain concerning terminologies and subvariants. To discuss open issues, the EU/US-consensus group and the European Competence Network on Mastocytosis (ECNM) launched a series of meetings and workshops in 2011-2013. Resulting discussions and outcomes are provided in this article. The group recommends that MML be recognized as a distinct condition defined by mastocytic differentiation in advanced myeloid neoplasms without evidence of SM. The group also proposes that MCL be divided into acute MCL and chronic MCL, based on the presence or absence of C-Findings. In addition, a primary (de novo) form of MCL should be separated from secondary MCL that typically develops in the presence of a known antecedent MC neoplasm, usually aggressive SM (ASM) or MC sarcoma. For MCL, an imminent prephase is also proposed. This prephase represents ASM with rapid progression and 5%-19% MCs in BM smears, which is generally accepted to be of prognostic significance. We recommend that this condition be termed ASM in transformation to MCL (ASM-t). The refined classification of MCL fits within and extends the current WHO classification; and should improve prognostication and patient selection in practice as well as in clinical trials.

The clinical manifestations and survival of systemic lupus erythematosus patients in Turkey: report from two centers

Background

Systemic lupus erythematosus (SLE) is a systemic autoimmune disease with a variety of clinical features. Survival has become longer as a result of better treatment modalities and better supportive care. There is no information on survival of SLE patients in Turkey. We evaluated clinical features and survival in SLE patients in two rheumatology departments.

Methods

All SLE patients being followed up by the Department of Rheumatology, Trakya University Medical Faculty, and the Department of Rheumatology, Marmara University Medical Faculty, over the 1996–2012 period were included. Patients were diagnosed with SLE if they fulfilled at least four American College of Rheumatology (ACR) criteria. The clinical and laboratory features, mortality data were obtained from medical charts.

Results

We had 428 SLE patients, and women (399 patients, 93.2%) far outnumbered men (29 patients, 6.8%). The mean age at the time of SLE diagnosis was 40.3 ± 12.4 years. The most frequent clinical manifestations were arthritis (76.9%) and photosensitivity (70.1%). Renal disease was present in 32.9% of patients and neurological involvement in 12.9% of patients. After a median follow-up of 60 months, 19 patients died. The most frequent causes of death were ischemic heart disease, chronic renal failure and sepsis. The rate of five-year survival was 96%; 10-year survival, 92%; and 15-year survival, 88.8%. Multivariate Cox analysis showed that serositis at the time of diagnosis, SLE disease activity index (SLEDAI) score 6, and autoimmune hemolytic anemia were independent prognostic factors.

Conclusions

Data from two centers in Northwestern Turkey show that the mortality rate for SLE is similar to the rate in Western countries.

Comparison of QuantiFERON-TB Gold test and tuberculin skin test for the identification of latent Mycobacterium tuberculosis infection in lupus patients

The tuberculin skin test (TST) has low sensitivity for the diagnosis of tuberculosis (TB). QuantiFERON-TB Gold (QFT-G) is an IFN-gamma-release assay that measures the release of interferon-gamma after stimulation in vitro by Mycobacterium tuberculosis antigens using ELISA. The main advantage of this assay compared with TST is the lack of cross-reaction with Bacillus Calmette-Guérin (BCG) as well as most of non-tuberculous mycobacteria. The aim of our study is to compare QFT-G with TST for the detection of latent tuberculosis infection (LTBI) among patients with systemic lupus erythematosus (SLE).

Methods: Seventy-eight patients with SLE and 49 healthy subjects (HCs) participated in the study. All patients and controls were interviewed for a history of TB then BCG vaccinations were recorded and chest X-rays were examined for a sign of TB infection. QTF-G and TST were performed on both patients and controls. QTF-G results were recorded as positive, negative or indeterminate. A positive TST for SLE was defined as ≥5 mm.

Results: Seventy-six SLE patients (97.4%) had been BCG vaccinated. Similar to the HC (28.5%), 19 of 78 (24.3%) SLE patients had positive QTF-G. Two patients had an indeterminate result. The agreement between QTF-G and TST was 49/76 (64.4%) (κ = 0.33). There were fewer positive QFT-G test results than positive TST results (24.3% vs. 50%; p < 0.01). Twenty-two (28.9%) patients were TST(+)/QTF-G(−) while only 3(3.9%) patients were TST(−)/QTF-G(+). When the positive TST was defined as ≥10 mm indurations, which is the cut-off in screening for LTBI in Turkey, the agreement between two tests increased up to 58/76 (76.3%) with a κ value of 0.47. The mean TST measurements was higher in QTF-G positive patients (13.4 ± 8.8 mm) than the QTF-G negative patients (4 ± 5.3 mm) ( p < 0.001).

Discussion: In a TB-endemic and BCG vaccinated population, the QuantiFERON-TB Gold assay seemed to be a more accurate test for the detection of LTBI in SLE patients. Although 5 mm is usually accepted to be the standard cut-off for TST in immunocompromised patients such as SLE, the level of agreement between QTF-G and TST was better with a 10 mm cut-off in our population.

Role of fibrinolytic parameters and plasminogen activator inhibitor 1 (PAI-1) promoter polymorphism on premature atherosclerosis in SLE patients

Premature atherosclerosis has been recognized as a major co-morbid condition in systemic lupus erythematosus (SLE). In this study, we aimed to investigate the effect of tPA (tissue plasminogen activator) and PAI-1 (plasminogen activator inhibitor) antigen concentrations and 4G/5G polymorphism of the PAI-1 gene on the development of atherosclerosis in SLE patients. One hundred and six SLE patients, 28 Takayasu arteritis (TA) patients and 98 healthy control subjects (HCs) were studied. PAI-1 and tPA antigen levels were measured by ELISA method. PAI-1 gene polymorphism was determined by using allele-specific PCR method. SLE patients had a significantly higher frequency (22.6%) of plaque (p = 0.01) and higher IMT (p=0.04) compared with HCs respectively. Only age at disease onset was associated with plaque formation in multivariate regression analysis (p = 0.001). Plasma tPA ag levels in SLE patients were significantly higher compared with HCs (p = 0.005) and PAI-1 ag levels were significantly higher compared with TA patients (p = 0.03). There were no significant differences between study groups in both genotype distribution and allele frequencies of PAI-1 gene, but SLE patients with 4G/4G genotype had higher IMT (p = 0.02) calcium scoring (p = 0.006) compared with 4G5G/5G5G genotypes. The present study suggests that measuring fibrinolytic parameters would have little additional benefit beyond traditional and novel risk factors in predicting coronary artery disease (CAD).

Heat shock proteins and myocardial protection during cardiopulmonary bypass

This prospective randomized study investigated the effects of two different cardioplegia techniques on myocardial heat shock protein 70 (HSP70) mRNA levels. Patients undergoing elective coronary artery bypass grafting with cardiopulmonary bypass (CPB) were divided into two equal groups. All patients received the same anaesthesia. Myocardial preservation was achieved by delivering intermittent antegrade isothermic blood cardioplegia in one group and antegrade plus continuous retrograde isothermic blood cardioplegia in the other. Biopsies for measurement of HSP70 mRNA levels were taken from the right atria before surgical manipulation of the heart, and later from the same place following CPB. HSP70 mRNA levels were evaluated using quantitative real-time reverse transcription-polymerase chain reaction. Crossing-point values for HSP70 and β-actin were used to evaluate up-regulation. There was a significant increase in HSP70 mRNA levels in response to CPB in both groups, but no significant between-group difference in HSP70 up-regulation. Further investigation is required to evaluate the correlation between the level of HSP induction and the degree of myocardial protection in more heterogeneous groups of patients.

Effect of antegrade graft cardioplegia combined with passive graft perfusion in on-pump coronary artery bypass grafting

Patients undergoing on-pump coronary artery bypass graft (CABG) with proximal graft anastomosis were randomly divided into groups that received antegrade cardioplegic infusion only via the aortic root (group A) or antegrade cardioplegic infusion via the aortic root and additional cardioplegia via vein or free arterial grafts after completion of each distal anastomosis (group B). The group B patients also received bypass graft perfusion with warm arterial blood just after removal of the cross-clamp until the proximal graft anastomosis was completed. The need for defibrillation and inotropic support during separation from cardiopulmonary bypass (CPB), and total CPB time were significantly lower in group B than in group A. Group B also had significantly lower peak cardiac troponin I levels 12 h after operation compared with group A and this was more pronounced in subgroups with severe right coronary artery stenosis and poor left ventricular ejection fraction than in the whole population. It is concluded that antegrade graft cardioplegia and graft perfusion with warm blood during proximal graft anastomosis may improve myocardial protection.

Characteristics of joint involvement and relationships with systemic inflammation in systemic sclerosis: results from the EULAR Scleroderma Trial and Research Group (EUSTAR) database

OBJECTIVE

To determine the prevalence of and independent factors associated with joint involvement in a large population of patients with systemic sclerosis (SSc).

METHODS

This study was cross-sectional, based on data collected on patients included in the European League Against Rheumatism (EULAR) Scleroderma Trials and Research (EUSTAR) registry. We queried this database to extract data regarding global evaluation of patients with SSc and the presence of any clinical articular involvement: synovitis (tender and swollen joints), tendon friction rubs (rubbing sensation detected as the tendon was moved), and joint contracture (stiffness of the joints that decreased their range of motion). Overall joint involvement was defined by the occurrence of synovitis and/or joint contracture and/or tendon friction rubs.

RESULTS

We recruited 7286 patients with SSc; their mean age was 56 +/- 14 years, disease duration 10 +/- 9 years, and 4210 (58%) had a limited cutaneous disease subset. Frequencies of synovitis, tendon friction rubs, and joint contractures were 16%, 11%, and 31%, respectively. Synovitis, tendon friction rubs, and joint contracture were more prevalent in patients with the diffuse cutaneous subset and were associated together and with severe vascular, muscular, renal, and interstitial lung involvement. Moreover, synovitis had the highest strength of association with elevated acute-phase reactants taken as the dependent variable.

CONCLUSION

Our results highlight the striking level of articular involvement in SSc, as evaluated by systematic examination in a large cohort of patients with SSc. Our data also show that synovitis, joint contracture, and tendon friction rubs are associated with a more severe disease and with systemic inflammation.

Recurrent multiple cardiac myxomas

BACKGROUND

The recurrence of cardiac myxoma after a surgical excision is a rare condition. The mechanism responsible for the recurrence remains unclear. Multifocal growth of a benign myxoma or malignant transformation, inadequate resection, intraoperative implantation or embolization, familial disposition, and the abnormal DNA ploidy pattern play an important role in development of recurrent myxoma.

CASE

We report the case of a 24-year-old female with recurrent multiple cardiac myxomas. She had an abortus 2 months ago. The patient had undergone a resection of left atrial and right ventricular myxoma with extension to the right pulmonary artery 8 years ago. The preoperative echocardiographic examinations revealed recurrent left atrial and right and left ventricular myxomas. The patient underwent a redo-surgery and, in addition to a large myxoma in the right ventricle with involvement of the tricuspid valve and anterior papillary muscle, three myxomas including both myxomas originating at the top and the base of the posterior papillary muscle, respectively, the other myxoma between both papillary muscles in the posterior wall of the left ventricle, and 2 more small myxomas including 1 in the interatrial septum and the other on atrial surface of anterior mitral annulus were found in the left ventricle and atrium. The myxomas were successfully excised through a transmitral approach with a combined bi-atrial incision. The tricuspid valve and mitral valve were repaired with annuloplasty. She had an uneventful postoperative course and no residual myxoma was found by echocardiography.

CONCLUSION

We think that a long-term follow-up by echocardiography in all patients after the resection of myxoma is advised for an early detection of any recurrence (Fig. 5, Ref. 9).

Important serum markers in malignant lymphoma

e22225

Background: In this study, 78 patients with new diagnosed, 21 patients with relapsed malignant lymphoma who applied to Cukurova University Hospital between March 2006 - 2008, and 36 age and sex matched healthy control group were evaluated and have been followed up. Methods: The aim of this study was to investigate if; any acute phase reactants or lymphocyte markers in peripheral blood have any predictive role concerning the treatment response, or disease progression. Results: Peripheral blood CD20 (+) lymphocyte levels were slightly higher in new diagnosed patients (12.09±13.79), than the control group (11.25 ±4. 79) but, much lower in relapsed patients (7.30±9.51, P= 0.038). After the chemotherapy (CT), CD20 (+) cell percentage decreased significantly only in new diagnosed patients (p<0.001). Pretreatment CD20 (+) cell levels were higher in responding patients than no responders (15. 42 ± 13.30 versus, 6.72 ± 5.24 p= 0.052). Peripheral blood CD 4 (+) cell levels were below the healthy control group (p= 0.01) and remained low after the CT. Interestingly, CD8 (+) cell levels increased in responders, after the CT (p= 0.046) in both patient groups. CD 56(+) lymphocyte levels were higher only in new diagnosed patients than healthy group (p= 0.05). Its level increased further after the CT (p= 0.044). Serum TNF α levels were higher in patient groups than control (p<0.001). Its level decreased following CT (p= 0.002). CRP levels were higher in both patient groups and remained high following the CT (p<0.001), regardless of the response status. Ferritin levels were also higher in patients groups (p<0.001). Pre-treatment serum ferritin levels were lower in responders, than no responders (236.65 ± 242.17 ng/ml versus 718.77 ± 645.24 ng/ml, p= 0.02). Serum prealbumine levels were lower in lymphoma patients than the healthy controls (p< 0.001). Its level was increased after treatment, especially in patients with recurrent disease (21.15± 5.89 versus 26.60 ± 7.29 mg/dl, p= 0.019). Conclusions: In conclusion, it was decided that; during the different stages of lymphoma progression, several mutations may occur, in the different components of the host immune system. Some of the immune responses would continue in spite of complete clinical remission, as some others would predict the response.

No significant financial relationships to disclose.