Vertebral Compression Fracture After Spine Stereotactic Body Radiotherapy: The Role of Vertebral Endplate Disruption

BACKGROUND AND OBJECTIVES

Vertebral compression fracture (VCF) is a common, but serious toxicity of spinal stereotactic body radiotherapy (SBRT). Several variables that place patients at high risk of VCF have previously been identified, including advanced Spinal Instability Neoplastic Score (SINS), a widely adopted clinical decision criterion to assess spinal instability. We examine the role of tumoral endplate (EP) disruption in the risk of VCF and attempt to incorporate it into a simple risk stratification system.

METHODS

This study was a retrospective cohort study from a single institution. Demographic and treatment information was collected for patients who received spinal SBRT between 2013 and 2019. EP disruption was noted on pre-SBRT computed tomography scan. The primary end point of 1-year cumulative incidence of VCF was assessed on follow-up MRI and computed tomography scans at 3-month intervals after treatment.

RESULTS

A total of 111 patients were included. The median follow-up was 18 months. Approximately 48 patients (43%) had at least one EP disruption. Twenty patients (18%) experienced a VCF at a median of 5.2 months from SBRT. Patients with at least one EP disruption were more likely to experience VCF than those with no EP disruption (29% vs 6%, P < .001). A nomogram was created using the variables of EP disruption, a SINS of ≥7, and adverse histology. Patients were stratified into groups at low and high risk of VCF, which were associated with 2% and 38% risk of VCF ( P < .001).

CONCLUSION

EP disruption is a novel risk factor for VCF in patients who will undergo spinal SBRT. A simple nomogram incorporating EP disruption, adverse histology, and SINS score is effective for quickly assessing risk of VCF. These data require validation in prospective studies and could be helpful in counseling patients regarding VCF risk and referring for prophylactic interventions in high-risk populations.

First detection of Ehrlichia chaffeensis, Ehrlichia canis, and Anaplasma ovis in Rhipicephalus bursa ticks collected from sheep, Turkey

Anaplasmosis and ehrlichiosis are important tick-borne rickettsial diseases of medical and veterinary importance that cause economic losses in livestock. In this study, the prevalence of Anaplasma ovis, Ehrlichia canis and Ehrlichia chaffeensis was investigated in ticks collected from sheep in various farms in Van province, which is located in the Eastern Anatolian Region of Turkey. The ticks used in this study were collected by random sampling in 26 family farm business in 13 districts of Van province. A total of 688 ticks were collected from 88 sheep and 88 tick pools were created. All ticks identified morphologically as Rhipicephalus bursa. Phylogenetic analysis of Chaperonin and 16S rRNA gene sequences confirmed A. ovis, E. canis and E. chaffeensis in this study. Of the 88 tick pools tested, 28.41% (25/88) were positive for at least one pathogen. Anaplasma DNA was detected in five of the 88 pools (5.68%), E. canis DNA was detected in 19 of the 88 pools (21.59%), and E. chaffeensis DNA was detected in one of the 88 pools (1.14%) of R. bursa ticks. To our knowledge, this is the first report describing the presence of A. ovis, E. canis, and E. chaffeensis in R. bursa ticks collected from sheep in Turkey. Further studies are needed to investigate other co-infections in sheep in Turkey.

Comparison of retinochoroidal and optic nerve head microvascular circulation between HIV-positive patients and healthy subjects using optical coherence tomography angiography

PURPOSE

To evaluate the retinal, choroidal, and optic disc head microvascular circulation in human immunodeficiency virus (HIV)-infected individuals without retinopathy receiving highly active antiretroviral therapy (HAART) using swept-source optical coherence tomography angiography (SS-OCTA).

METHODS

This cross-sectional study included 100 eyes of 100 patients with HIV infection but no HIV-related ocular disease and 108 eyes of 108 age- and sex-matched healthy subjects as the control group. SS-OCTA was used to assess foveal avascular zone (FAZ) area, retinal nerve fiber layer thickness (RNFL), choriocapillaris (CC) flow area, outer retinal (OR) thickness, radial peripapillary capillary (RPC) vessel density (VD), ONH VD, and choroidal thickness.

RESULTS

No statistically significant difference was found between the two groups except in the foveal VD of the deep capillary plexus (DCP). The foveal VD of the DCP was lower in the HIV-positive group (P=0.011). The mean FAZ area (mm2), perimeter (mm), and CC flow area (mm) values were higher in the HIV-positive group at statistically significant levels (P=0.021, P=0.02, and P=0.039, respectively). However, no statistically significant differences were found between the two groups concerning the OR flow area, subfoveal choroidal thickness, or the VDs of the RPC or ONH.

CONCLUSIONS

This is the first study in the literature to evaluate the microvascular circulation of the ONH in HIV-positive patients. Although retinal and choroidal microvascular circulation decreased in HIV-positive patients receiving HAART treatment, we found no effect on the microvascular circulation of the ONH or RPC microvascular circulation. Our findings suggest that retinochoroidal microvascular circulation is affected in HIV-positive patients over time.

Multi-institutional consensus on machine QA for isochronous cyclotron-based systems delivering ultra-high dose rate (FLASH) pencil beam scanning proton therapy in transmission mode

BACKGROUND

The first clinical trials to assess the feasibility of FLASH radiotherapy in humans have started (FAST-01, FAST-02) and more trials are foreseen. To increase comparability between trials it is important to assure treatment quality and therefore establish a standard for machine quality assurance (QA). Currently, the AAPM TG-224 report is considered as the standard on machine QA for proton therapy, however, it was not intended to be used for ultra-high dose rate (UHDR) proton beams, which have gained interest due to the observation of the FLASH effect.

PURPOSE

The aim of this study is to find consensus on practical guidelines on machine QA for UHDR proton beams in transmission mode in terms of which QA is required, how they should be done, which detectors are suitable for UHDR machine QA, and what tolerance limits should be applied.

METHODS

A risk assessment to determine the gaps in the current standard for machine QA was performed by an international group of medical physicists. Based on that, practical guidelines on how to perform machine QA for UHDR proton beams were proposed.

RESULTS

The risk assessment clearly identified the need for additional guidance on temporal dosimetry, addressing dose rate (constancy), dose spillage, and scanning speed. In addition, several minor changes from AAPM TG-224 were identified; define required dose rate levels, the use of clinically relevant dose levels, and the use of adapted beam settings to minimize activation of detector and phantom materials or to avoid saturation effects of specific detectors. The final report was created based on discussions and consensus.

CONCLUSIONS

Consensus was reached on what QA is required for UHDR scanning proton beams in transmission mode for isochronous cyclotron-based systems and how they should be performed. However, the group discussions also showed that there is a lack of high temporal resolution detectors and sufficient QA data to set appropriate limits for some of the proposed QA procedures.

Occurence and genotype distributionof Cryptosporidium spp.,and Giardia duodenalis in sheep in Siirt, Turkey

Cryptosporidium spp., and Giardia duodenalis are intestinal protozoan parasites known to infect humans and various animals and cause diarrhea. This study aimed at determining the prevalence and genotype of Cryptosporidium spp. and Giardia duodenalis in sheep in different locations of Siirt province. The fecal material for this study was collected from 500 sheep in different locations of Siirt province, Turkey. Fecal samples obtained from sheep were examined for Cryptosporidium spp. by Kinyoun Acid Fast staining and the Nested PCR method. Microscopic and Nested PCR methods revealed a prevalence of 2.4% (12/500) and 3.6% (18/500), respectively. Sequence analysis revealed the presence of C. ryanae, C. andersoni, and zoonotic C. parvum. In terms of Giardia duodenalis, 8.4% (42/500) and 10.2% (51/500) prevalence was determined using Nativ-Lugol and Nested PCR methods, respectively. Using sequence analysis, zoonotic assemblages A and B as well as assemblages E and D were detected. As a result of this study, both the prevalence of Cryptosporidium spp. and Giardia duodenalis and the presence of species that appear to be host-specific, as well as those known to be zoonotic, were revealed. A large-scale study is needed to understand the impact of these agents on sheep farming and their consequences on human health.

POS1507-HPR INVESTIGATION OF THE EFFECTS OF PELVIC FLOOR TRAINING ON PAIN, SEXUAL DYSFUNCTION, AND QUALITY OF LIFE IN FEMALE PATIENTS WITH SJOGREN

Background

Sjogren’s syndrome is a chronic systemic inflammatory disorder (classified as an autoimmune disorder) characterized by lymphocyte infiltrates in exocrine organs. This syndrome is classified as primary sjogren’s or secondary sjogren’s. Dryness of the eyes, oral cavity, larynx, pharynx and vagina is common in primary sjogren’s syndrome. Although vaginal dryness is a symptom seen after menopause in the healthy population, it often occurs at a young age in cases with primary sjogren’s.

The presence of urogynecological complaints in women with pSS adversely affected the health-related quality of life of pelvic floor function. However, it has been shown that the sexual functions of women with pSS are also negatively affected. Sexual dysfunction and increased pain were seen with increasing pelvic floor dysfunctions. Many studies showing that pelvic floor training has been accepted in the literature as the first step in the treatment of pelvic floor dysfunctions to increase pelvic floor strength and effectiveness. In addition, the positive effects of pelvic floor exercises on sexual functions have been supported by studies.

Objectives

The aim of this study was to investigate the effects of pelvic floor training on pain, sexual dysfunction and quality of life in female patients with pSS and determine whether pelvic floor training was superior to education program.

Methods

46 pSS patients (46 female) with an average age of 47.78±9.18 were included in the study. Patients were divided into two groups by block randomization method. Group 1 received 30 minutes of pelvic floor training program every day as a home exercise for 8 weeks. Group 2 received education about pelvic floor muscles and daily living activities. Health Assessment Questionnare (HAQ) was used to evaluate the quality of life, Visual Analog Scale (VAS) and Pelvic Pain Impact Questionnaire (PPIQ) was used to evaluate degree of pelvic pain, Pelvic Floor Disability Index-20 (PFDI-20) was used to evaluate the degree of certain discomfort caused by pelvic symptoms in women, Female Sexual Function Scale (FSFI) was used to evaluate the sexual dysfunction, Pelvic Floor Impact Questionnaire (PFIQ-7) was used to evaluate the effect of bladder, bowel, and pelvic symptoms on the individual’s activities of daily living, social relationships, and emotions. All evaluations were performed at baseline and at the end of the 8th week.

Results

When the groups were compared before training, there was no significant difference (p> 0.05). In post-training comparisons, there was a significant difference in FSFI, VAS, PPIQ, PFIQ-7, PFDI-20 in pelvic floor training group (p:0.02-0.00); in FSFI-lubrication, PFIQ-7 and PFDI-20 (p:0.00-0.03) in education group. In addition, after post-training, pelvic floor training group was found to be superior in terms of FSFI total (Z: -3.40, p: 0.01), FSFI-orgasm (Z: -3.13, p: 0.02), FSFI-satisfaction (Z: -2.27,p: 0.02), FSFI-pain (Z: -2.42, p: 0.01), PFDI-20 (Z: -3.42, p: 0.00), POPDI-6 (Z: -3.00, p: 0.00), CRADI-8 (Z: -2.18, p: 0.02), UDI-6 (Z: -3.64, p: 0.00) compared with education group.

Conclusion

As a result of our study, pelvic floor training has a positive effect on sexual dysfunction and discomfort caused by pelvic symptoms in patients with pSS. Pelvic floor training should be included in rehabilitation programs as a home exercise to improve sexual function and pelvic floor dysfunctions for patients with pSS.

References

[1]Yang EJ, Lim JY, Rah UW, Kim YB. Effect of a pelvic floor muscle training program on gynecologic cancer survivors with pelvic floor dysfunction: a randomized controlled trial. Gynecol Oncol. 2012;125(3):705-11.

[2]Cetin, SY, Buyuk, A, Ayan, A. Investigation of the relationship between the pelvic floor and sexual dysfunction in women with Sjogren’s syndrome. Int J Rheum Dis. 2020; 23: 1728– 1733.

[3]Bø K, Talseth T, Vinsnes A. Randomized controlled trial on the effect of pelvic floor muscle training on quality of life and sexual problems in genuine stress incontinent women. Acta Obstet Gynecol Scand. 2000 Jul;79(7):598-603.

Disclosure of Interests

None declared

Evaluations of the radial peripapillary, macular and choriocapillaris microvasculature using optical coherence tomography angiography in patients with systemic sclerosis

PURPOSE

To analyze the macular microvascular (MMV) architecture, radial peripapillary capillary (RPC) network and choriocapillaris using optical coherence tomography angiography (OCT-A) in patients with systemic sclerosis (SSc) without systemic comorbidities.

METHODS

The vessel densities (VDs) of the MMV, foveal avascular zone (FAZ) parameters, choriocapillaris flow areas (CCFAs), RPC VDs, and optic nerve head (ONH) parameters were measured by OCT-A. Retinal thickness and subfoveal choroidal thickness (SFCT) were measured by spectral-domain optical coherence tomography (SD-OCT). The SD-OCT and OCT-A measurements of 53 eyes of 30 SSc patients were compared with 61 eyes of 33 healthy controls.

RESULTS

In the MMV analysis, a decrease in the VDs of the superficial capillary plexus and an increase in the FAZ area, FAZ perimeter and non-flow area were detected in the SSc group compared to the controls (P=0.007, P=0.001, P=0.029, P=0.018, and P=0.039, respectively). While there was a decrease in SFCT, no change was found in CCFA (P=0.001 and P=0.902, respectively). The RPC analysis revealed a decrease in the VDs of all vessels for the entire area and the intradisc area, as well as the VDs of the small vessels for the intradisc area (P=0.021, P=0.001, and P=0.003, respectively). In the ONH analysis, there was an increase in the C/D area ratios and cup volumes, and a decrease in the rim areas and nasal quadrant retinal nerve fiber layer thickness (P=0.004, P=0.004, P=0.013, and P=0.032, respectively).

CONCLUSION

Decreases in RPC and MMV VDs and changes in ONH parameters were found in OCT-A measurements in patients with SSc.

Synchronous thyroid cancer on the edge: Incidentalomas of 18F-FDG PET/CT in clinical practice

Aims

The objective of this study was to discuss the outcomes of the oncology patients whose PET/CT scans show incidental focal thyroid 18F-FDG uptake.

Methods

This retrospective analysis examined 2575 18F-FDG PET/CT scans from 1803 patients with no known thyroid cancer history. The survival rates were analyzed for patients with and without cytopathological evaluation.

Results

Increased metabolic activity of the thyroid was detected in 96 patients. Of those, 72 were diagnosed with a focal uptake of 18F-FDG and 24 subjects had a diffuse uptake. All 72 patients with a focal uptake were referred for ultrasound (US) and fine-needle aspiration cytology (FNAC). Of those patients, 44 were admitted for US and 16 underwent FNAC. The mean SUVmax was 16.0 ± 7.97 for patients with malignant lesions and 3.24 ± 0.88 for patients with benign lesions (p = 0.023). The mortality rate was higher in the patients who were not evaluated with FNAC.

Conclusion

Patients with incidental focally increased thyroid 18F-FDG accumulation on PET/CT are known to have a high risk of malignancy. These patients require additional diagnostic procedures to distinguish the underlying pathology. However, the clinical condition of these patients will be the primary concern when performing these procedures.

Contemporary Understandings of Cardiovascular Disease After Cancer Radiotherapy: a Focus on Ischemic Heart Disease

PURPOSE OF REVIEW

Radiation-induced cardiovascular disease, including coronary artery disease, is a well-known sequela of radiation therapy and represents a significant source of morbidity and mortality for cancer survivors. This review examines current literature and guidelines to care for this growing population of cancer survivors.

RECENT FINDINGS

The development of radiation-induced ischemic heart disease following radiation can lead even to early cardiotoxicities, inclusive of coronary artery disease, which limit cancer treatment outcomes. These coronary lesions tend to be diffuse, complex, and proximal. Early detection with multimodality imaging and targeted intervention is required to minimize these risks. Early awareness, detection, and management of radiation-induced cardiovascular disease are paramount as cancer survivorship continues to grow.

AB1324-HPR INVESTIGATION OF THE RELATIONSHIP BETWEEN SOCIAL APPEARANCE ANXIETY AND DISEASE DURATION, SELF-ESTEEM, ANXIETY AND DEPRESSION IN RHEUMATOLOGICAL DISEASES-PRELIMINARY STUDY

Background:

Appearance anxiety means discomfort in social interactions due to changes in appearance. Also this anxiety; it is the fear of being evaluated negatively and worry about the changes in appearance, and it is not only apparent. Body image is the emotions, thoughts and perceptions of the individual about his or her own body and directly affects self-esteem. The Social Appearance Anxiety Scale (SAAS) was developed to assess social appearance anxiety, and this scale was found to be a valid and reliable scale in scleroderma (SSc) patients. It was also thought to be related to the severity of the disease. The literature shows that appearance concerns are strongly related to depression in patients with rheumatic disease and should be evaluated routinely.

Objectives:

The first aim of the study is to determine the level of social appearance anxiety in rheumatology patients, and our last goal is to investigation of the relationship between social appearance anxiety and disease duration, self-esteem, depression and anxiety.

Methods:

129 rheumatology patients with a mean age of 42.96 ± 11.33 years (51 men, 78 women) were included in the study. 55% of patients were ankylosing spondylitis (AS), 15.5% of patients were sjögren syndrome (SS), 11.6% of patients were rheumatoid arthritis (RA), 7.8% of patients were fibromyalgia syndrome (FMS), 6.2% of patients were SSc, 2.3% of patients were Behçet’s disease (BD) and 1.6% were diagnosed with psoriatic arthritis (PsA). The Social Appearance Anxiety Scale (SAAS) was used to evaluate patients’ social appearance anxiety, the Rosenberg Self-Esteem Scale (RSES) was used to evaluate self-esteem, and the Hospital Anxiety and Depression Scale (HADS) was used to evaluate depression and anxiety.

Results:

The disease duration was found to be 6.82 ± 5.22 years. The SAAS average was found to be 43.23 ± 20.53 points. It was found that the SAAS values of patients with PsA and SSc were higher than patients with AS, RA, FMS, SS, BD. A moderate positive correlation was found between SAAS and disease duration, depression and anxiety (p: 0.048, r: 0.545; p: 0.007, r: 0.638; p: 0.014, r: 0.749, respectively).

Conclusion:

As a result of the study, it was observed that rheumatology patients had moderate and high level social appearance anxiety. We thought that they have a higher level of social appearance anxiety because of skin involvement in patients with with PsA and SSc. In addition, as a result of the study, we found that as the social appearance anxiety increased, disease duration, depression and anxiety increased. According to this study, in which the preliminary results are given, we thought that it is necessary to determine patients’ appearance anxiety in routine evaluation and to reduce social appearance anxiety by collaboration with multidisciplinary areas in rheumatological diseases.

References:

[1]Mills SD, Kwakkenbos L, Carrier ME, Gholizadeh S, Fox RS, Jewett LR, Gottesman K, Roesch SC, Thombs BD, Malcarne VL. Scleroderma Patient-centered Intervention Network InvestigatorsValidation of the Social Appearance Anxiety Scale in Patients With Systemic Sclerosis: A Scleroderma Patient-Centered Intervention Network Cohort Study Arthritis Care Res (Hoboken) 2018; 70 (10): 1557-1562.

[2]Jung J, Lee S-H. Behavior between korean and U.S. women cross-cultural comparisons of appearance selfschema, body image, self-esteem, and dieting. Family and Consumer Sciences Research Journal 2006; 34: 350.

[3]Hart TA, Flora DB, Palyo SA, Fresco DM, Holle C, Heimberg RG. Development and examination of the Social Appearance Anxiety Scale. Assessment 2008;15:48–59.

[4]Monaghan SM, Sharpe L, Denton F, Levy J, Schrieber L, Sensky T. Relationship Between Appearance and Psychological Distress in Rheumatic Diseases Arthritis Rheum 2007; 57 (2): 303-9

Disclosure of Interests:

None declared

AB0547 INVESTIGATION OF THE PRESENCE OF FIBROMYALGIA SYNDROME IN PATIENTS WITH SCLERODERMA

Background:

As with other connective tissue diseases, fibromyalgia (FMS) syndrome is not uncommon in scleroderma. However, there is no clear information about it in the literature. According to 1990 ACR criteria, sensitive point evaluation was made in scleroderma and FMS frequency was reported as 18.6% in scleroderma patients. However, it is known that fibrosis creates difficulties in sensitive point determination. moreover, ACR 1990 criteria cannot be met in approximately 25% of fibromyalgia patients. Therefore, the frequency of fibromyalgia in scleroderma patients is unclear. In 1990, ACR announced new criteria in 2010 due to the low sensitivity of ACR criteria to FMS detection and not being used in the follow-up of the disease. In the new set of criteria, not the 18 sensitive point evaluations, but the Widespread Pain Index and Symptom Severity Scale are evaluated.

Objectives:

In this study, we planned to investigate the frequency of fibromyalgia in systemic sclerosis patients according to the new ACR criteria defined in 2010.

Methods:

43 patients with diffuse systemic sclerosis with no known additional diseases were included in the study. Patients were evaluated with the new fibromyalgia diagnostic criteria set. Patients were evaluated with Fibromyalgia Impact Questionnaire (FIQ), Pain Location Score (PLS), Symptom Impact Questionnaire (SEA), Widespread Pain Index (WPI) and Symptom Severity Scale (SSS).

Results:

The mean age of the patients was 53.45 ± 12.87 years (39 women, 4 men). Mean values were FIQ: 46.05 ± 17.44, PLS:18.32 ± 9.87, SEA: 20.76 ± 11.31, WPI: 7.93 ± 5.87, SSS: 6.51 ± 3.41 respectively. According to these results, 62.8% (n: 27) FMS presence of SS patients was detected.

Conclusion:

In the literature, there are only a few studies evaluating the frequency of FMS in scleroderma patients. Malcarne et al. reported that 18.6% of 102 SSc patients met the 1990 classification criteria for FMS. However, there are predominantly early-stage systemic sclerosis patients in this study and the patient group is heterogeneous. We included patients with diffuse systemic sclerosis and widespread skin involvement in this study. we found a much higher frequency of fibromyalgia syndrome than indicated in the literature. Considering that systemic sclerosis is a serious disease that significantly impairs quality of life, this finding is very important. In order to relieve the symptoms associated with FMS, it is important to provide them with additional medical support, to provide as much exercise as possible, and to provide group therapies to improve patients’ quality of life.

References:

[1]Management of Musculoskeletal Involvement in Systemic Sclerosis. Philip Clements. Curr Treatm Opt Rheumatol. 2016 Mar; 2(1): 61–68.

[2]Malcarne VL, Hansdottir I, McKinney A, Upchurch R, Greenbergs HL, Henstorf GH, Furst DE, Clements PJ, Weisman MH. Medical signs and symptoms associated with disability, pain, and psychosocial adjustment in systemic sclerosis. J Rheumatol. 2007;34:359–367.

Disclosure of Interests:

None declared

AB1307-HPR INVESTIGATION OF THE EFFECTIVENESS OF TAI CHI EXERCISE PROGRAM ON CARDIOPULMONARY FUNCTIONS AND QUALITY OF LIFE IN PATIENTS WITH SYSTEMIC SCLEROSIS

Background:

Systemic sclerosis (SSc) is an autoimmune disease that not only affects the skin but also causes symptoms that involve important internal organs such as joints, muscles, and heart and lungs. Due to all these multiple system involvements, the quality of life of individuals with scleroderma decreases. Tai Chi Chuan is a combination of physical exercise and relaxation techniques, and it is a traditional Chinese exercise method used to improve mental and physical health of people. There are many studies showing that Tai Chi improves the body’s aerobic capacity and psychological well-being. In the literature, Tai Chi has been shown to reduce pain, improve physical function, improve healing effects on depression and quality of life, especially, in the elderly, individuals with musculoskeletal diseases such as rheumatoid arthritis and osteoarthritis, and improve cardiac vascular risk factors such as hypertension and diabetes.

Objectives:

The aim of the study is to examine the effectiveness of Tai Chi on cardiopulmonary functions and quality of life in patients with SSc.

Methods:

28 SSc patients (25 females, 3 males) with an average age of 53.00 ± 10.00 were included in the study. For training, patients were divided into two groups by block randomization method. Group 1 received 60 minutes of Tai Chi exercise program and Group 2 received 60 minutes of home exercise for 2 days a week for 8 weeks. 6-min walk test (6MWT) and St. George Respiratory Questionnaire was used to evaluate the cardiopulmonary functions, Short form 36 (SF-36) was used to evaluate the quality of life. All evaluations were performed at baseline and at the end of the 8th week

Results:

When the groups were compared before training, there was no significant difference (p> 0.05). In post-training comparisons, there was a significant difference in all parameters in Tai Chi group (p: 0.001-0.045); there was a significant difference in the physical function sub-parameter of SF-36 and 6MWT in the home exercise group (p: 0.045, p: 0.038, respectively). Comparing the post-training groups, Tai Chi group was found to be superior in terms of all parameters compared to the home exercise group (p: 0.00-0.04). No side effects were observed during the exercises.

Conclusion:

As a result of our study; Tai Chi has a possitive effect on cardiopulmonery function and quality of life in patients with SS. Tai Chi should be included in rehabilitation programs as a safe alternative type of exercise to improve cardiopulmonery function and quality of life in patients with SSc.

References:

[1]de Oliveira NC, Portes LA, Pettersson H, Alexanderson H, Boström C. Aerobic and resistance exercise in systemic sclerosis: State of the art. Musculoskeletal Care. 2017;15:316–323.

[2]Jia X, Jiang C, Tao J, Li Y, Zhou Y, Chen LD. Effects of core strength training combined with Tai Chi Chuan for the musculoskeletal system and cardiopulmonary function in older adults: A study protocol for a randomized controlled trial. Medicine (Baltimore). 2018;97(35):e12024.

[3]Wang C, Schmid CH, Hibberd PL, Kalish R, Roubenoff R, Rones R, McAlindon T. Tai Chi is effective in treating knee osteoarthritis: a randomized controlled trial. Arthritis Rheum. 2009; 61:1545–1553.

[4]Wang C, Roubenoff R, Lau J, Kalish R, Schmid CH, Tighiouart H, Rones R, Hibberd PL Effect of Tai Chi in adults with rheumatoid arthritis. Rheumatology (Oxford) 2005; 44:685–687.

Disclosure of Interests:

None declared

AB1012 INVESTIGATION OF RELATIONSHIP BETWEEN SEXUAL FUNCTION AND OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IN PATIENTS WITH BEHÇET’S: PRELIMINARY STUDY

Background:

Patients with Behçet’s have sexual dysfunction in recently literature. However, depression and anxiety accompanying these studies were not excluded. In addition, increased sexual dysfunction in patients with Behçet’s has been reported in these studies in relation to depression and anxiety. Also it has been stated that endothelial dysfunction decreases the vasodilator neurotransmitter level. It was emphasized that this may lead to erectile dysfunction in disease of Behçet’s.

Objectives:

The aim of this study is to evaluate the relationship between erectile dysfunction (ED) and radial peripapillary capillary (RPC) density determined by Optical Coherence Tomography Angiography (OCTA).

Methods:

Patients under 45 years old who had no known additional disease and had no eye and neurological involvement were included in the study. The patients were evaluated with Beck Depression and Anxiety Scale. Accordingly, patients without anxiety and depression were included in the study. An International Index of ErectileFunction (IIEF) questionnaire was applied to a total of 18 patients who met the inclusion criteria. Detailed ophthalmological examination and OCTA imaging were performed by the ophthalmologist. Patients whose eye bottom could not be evaluated clearly (Corneal pathology, cataracts, etc.), image quality was 0.5 and below, and additional eye disease (glaucoma, optic neuropathy, maculopativb) were excluded from the study.

Results:

The mean age of the patients was 37 ± 6.5 years, and the duration of the disease was 82.37 ± 47.78 months. There was a strong relationship between RPC Small Vessel Whole Density (RPC-SVWD) and overall satisfaction and sexual satisfaction (p: 0.036 and 0.045). There was a strong positive relationship between RPC Small Vessel Peripapillary Density (RPC-SVPD) and erectile function, sexual desire, sexual satisfaction and general satisfaction (p: 0.036, 0.032, 0.005, 0.004). There was a strong positive relationship between RPC All Vessel Peripapillary Density (RPC-AVPD) and erectile function and sexual satisfaction (p: 0.048, 0.015).

Conclusion:

In our study, a significant relationship was found between sexual function and RPC density. In the literature, it has been found that nitric oxide synthesis decreases due to endothelial dysfunction in patients with Behçet’s. Although there are preliminary study data, we found a significant relationship between the vascular layer of both the penis and the eye in our study. The data we obtained in this study, in which all factors that may cause erectile dysfunction are excluded, show that Behçet’s, which is theoretically known to affect all vascular structures, can affect sexual functions by its nature. In our study, although there is a relationship between ED and OCTA data in Behçet’s disease, the large number of cases of our ongoing study will provide clearer information.

References:

[1]Erdemir F, Atilgan D, Boztepe Ö, Aytan P, Uluocak N, Taliyurt T. Is there a relationshipbetween Behçet disease and erectile dysfunction? Turkish Journal of Urology 2010; 36:380-386.

[2]Rosen RC, Riley A, Wagner G Osterloh IH, Kirkpatrick J, Mishra A. The international index of erectilefunction (IIEF): a multidimensional scale for assesment of erectile dysfunction. Urology 1997; 49: 822–830.

[3]Validation Group of Turkish Society of Andrology. International Index of Erectile Function (IIEF) Turkish version, 4th National Sexual Dysfunction Congress Abstract Book, pp 43, 2002.

[4]Örem A, Ertürk M, Cimşit G, Kural BV. Effect of plasma from patients with Behçet disease on the production of nitricoxide in cultured human umbilical vein endothelial cells. Med Princ Pract 2004;13:35-8.

Disclosure of Interests:

None declared

Different patterns of hepatocellular carcinoma-related malign thrombosis in 18F-FDG PET/CT

Tumor thrombus is an intravascular malign tumor extension that may occur in various types of cancer. Hepatocellular carcinomas (HCC) are common causes of malign thrombus. The presence of a malign thrombus due to HCC has a dismal prognosis, which affects treatment choices. We present three cases of tumor thrombi due to advanced HCC detected by ¹⁸F-FDG PET/CT.

Increasing Radiation Dose to the Thoracic Marrow Is Associated With Acute Hematologic Toxicities in Patients Receiving Chemoradiation for Esophageal Cancer

Purpose: To test the hypothesis that increasing radiation dose to the thoracic marrow (TM) contributes to the development of hematologic toxicities (HT) in esophageal cancer (EC) patients receiving chemoradiation therapy (CRT).

Methods: We identified EC cases treated with curative intent CRT at our institution from 2007 to 2016. The TM was contoured as the union of the vertebral bodies (VB) from T1-L1, the ribs from T1-L1, and the sternum. The TM-mean dose and the TM volume receiving at least 5–50 Gy (V5-V50) were collected. Grade ≥ 3 HT (HT3+) was the primary endpoint. Normal tissue complication probability (NTCP) was evaluated using the Lyman-Kutcher-Burman (LKB) model. Logistic regression was used to test associations between HT3+ and dosimetric parameters. Odds ratios (OR) and 95% confidence intervals (CI) are reported with p < 0.05 considered significant. Receiver operating characteristics analysis was used to determine optimal cut points.

Results: We identified 137 EC cases, and most received concurrent carboplatin/paclitaxel (N = 83). Median radiation dose was 50.4 Gy (IQR = 50.4–50.4 Gy). The rate of HT3+ was 39.4%. Optimization of the LKB model yielded the results n = 0.70, m = 0.67, and TD₅₀ = 20.1 Gy. The TM-V30 was most strongly associated with HT3+ and on multivariate analysis, patients with TM-V30 ≥ 14% had a 5.7-fold (95% CI 2.42–14.54, p < 0.001) increased odds of HT3+ in the entire cohort and a 4-fold (95% CI 1.54–11.11, p = 0.006) increased odds of HT3+ in the carboplatin/paclitaxel cohort compared to patients with TM-V30 < 14%. Radiation dose to the VB and rib sub-sites of the TM were also associated with HT3+, particularly VB-V40.

Conclusion: We found that increasing TM radiation dose was associated with HT3+ in EC patients treated with CRT. Radiation dose to the VB and rib sub-sites were also associated with HT3+. These findings suggest that limiting radiation dose to the TM (or its sub-sites) may be sufficient to decrease HT3+, but further prospective evaluation of these results is needed.

Radiation Dose to the Thoracic Vertebral Bodies Is Associated With Acute Hematologic Toxicities in Patients Receiving Concurrent Chemoradiation for Lung Cancer: Results of a Single-Center Retrospective Analysis

PURPOSE

To test the hypothesis that increasing radiation therapy (RT) dose to the thoracic vertebral bodies (TVBs) contributes to the development of hematologic toxicities (HTs) in patients with lung cancer.

METHODS AND MATERIALS

Cases of non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) treated with definitive chemoradiation with concurrent platinum-based doublet chemotherapy at our institution from 2007 to 2016 were identified. Mean TVB dose and the volume of TVBs receiving at least 5 to 60 Gy (V₅-V₆₀) were retrospectively recorded. Logistic regression was used to test associations between grade ≥3 HT (HT3+) and dosimetric/clinical parameters. Normal tissue complication probability was evaluated using the Lyman-Kutcher-Burman (LKB) model for HT3+, and receiver operating characteristics analysis was used to determine dosimetric cut-points.

RESULTS

We identified 201 patients, the majority having NSCLC (n=162, 81%) and stage III to IV disease (n=179, 89%). All patients received either cisplatin/etoposide (n=107, 53%) or carboplatin/paclitaxel (n=94, 47%). Median RT dose was 60 Gy (range, 60-70 Gy). The rate of HT3+ was 49% (n=99). Increasing mean TVB dose (per Gy) was associated with higher odds of developing HT3+ (odds ratio 1.041, 95% confidence interval 1.004-1.080, P=.032), as were increasing TVB V₅ to V₂₀. These dosimetric correlates to HT3+ persisted on multivariate analysis. Constrained optimization of the LKB model for HT3+ yielded the parameters: n=1, m=1.79, and TD₅₀=21.4 Gy. Optimal cut-points identified were V₅=65%, V₁₀=60%, V₂₀=50%, and mean dose=23.5 Gy. Patients with values above these cut-points had an approximately 2-fold increased risk of HT3+.

CONCLUSIONS

We found that mean TVB dose and low-dose parameters (V₅-V₂₀) were associated with HT3+ in chemoradiation for lung cancer. Per the LKB model, bone marrow behaves like a parallel organ (n=1), implying that mean TVB dose is a useful predictor for toxicity. These data suggest that efforts to spare dose to the TVBs may reduce rates of severe HT.

The efficacy of chloroquine treatment of Giardia duodenalis infection in calves

The purpose of the present study was to evaluate the effect of chloroquine treatment on cyst excretion in calves naturally infected with Giardia duodenalis. The calves were randomly assigned into two groups based on placebo (group I, n=7 untreated control calves) or treatment (group II, n=7 calves treated orally with 2.5 mg/kg chloroquine twice daily for five consecutive days). The G. duodenalis isolates were identified by molecular characterization with β-giardin nested PCR and gene sequence analysis as assemblage A3. Cyst excretion was determined on days 0, 3, 7 and 10, before and after treatment. Geometric means of the number of excreted cysts did not change significantly in the control group during the trial. The reduction in cyst excretion after chloroquine treatment was 99% on day 3 and 100% on days 7 and 10. Chloroquine treatment is most probatly practically applicable, relatively inexpensive and highly effective against giardiosis in calves.

The increased risk of globus pharyngeus in patients with chronic thyroiditis: a case control study

OBJECTIVE

A correlation between globus pharyngeus and thyroid gland inflammation has been mentioned in previous studies. However, the potential risk of globus pharyngeus in chronic thyroiditis patients has not been shown so far. The aim of this study is to investigate a possible association between chronic thyroiditis and globus pharyngeus.

PATIENTS AND METHODS

The study was performed in an ultrasound (US) center of a tertiary health care institution. Ninety-two patients who were under examination for suspected thyroid pathologies or undergoing follow-up for a previously diagnosed thyroid disease were enrolled in the study. The patients were divided into two groups according to the existence of globus symptoms. Subsequently, all patients underwent high-resolution thyroid ultrasounds. The patients whose ultrasound findings were suggestive of chronic thyroiditis constituted the second subgroup. The demographic data of the patients and other ultrasound findings including the volume of the thyroid glands and nodules, if any, were noted as well.

RESULTS

Sixty-seven female (73%) and 25 male (27%) patients were enrolled in the study. Thirty-two (35%) of the 92 patients constituted the globus pharyngeus group according to their responses to the questionnaire and the US findings were concordant with chronic thyroiditis in 36 (39%) patients. The correlation between chronic thyroiditis and globus sensation was significant (p = 0.004), and the odds ratio was calculated as 3.7 (95% CI = 1.5-9.11). Other parameters including age, sex, thyroid volume and nodule status were not significantly related to globus pharyngeus in this particular patient series.

CONCLUSIONS

In the presented study, the risk of globus pharyngeus occurrence was calculated as 3.7-fold higher in patients with chronic thyroiditis. Being a preliminary report, it is necessary to confirm this finding and understand the pathophysiological mechanism via further investigations with a larger patient series.

Prevention of bone loss by Panax ginseng in a rat model of inflammation-induced bone loss

This study evaluated the protective effect of Panax Ginseng (PG) on bone metabolism in an experimental ovariectomy (OVX) model of osteoporosis in which inflammation was induced by subcutaneous magnesium silicate. The groups were: sham control (Group1, SH), sham+inflammation (Group2, SHinf), OVX (Group3), OVX+inflammation (Group4, OVXinf), OVX+inflammation+PG 100 mg/kg (Group5, OVXinf+PG1), OVX+inflammation+PG 200 mg/kg (Group6, OVXinf+PG2), OVX+PG 100 mg/kg (Group7, OVX+PG1), OVX+PG 200 mg/kg (Group8, OVX+PG1). After the OVX surgery, all the groups were allowed to recover for two months. On the 59th day after the OVX, inflammation was induced in Groups 2, 4, 5, and 6 by subcutaneous injections of magnesium silicate in the back of the animals. Groups 5 and 7 were administered oral PG 100 mg/kg, and Groups 6 and 8 were administered oral PG 200 mg/kg from the 60th to the 80th day. PG 200 mg/kg was able to restore BMD, up to values measured in both the OVX and the SH animals. The levels of OC and OP decreased in OVXinf+PG1 and OVXinf+PG2 groups. The serum levels of TNF—α, IL—1β, and IL—6 were increased significantly in the OVXinf rats compared with the SH group. The present data showed that PG protected against in the OVX model and in inflammation-induced bone loss rat model.

The effect of systemically administrated zoledronic acid on the osseointegration of dental implants

OBJECTIVE

The aim of conducting this study was to evaluate the effect of zoledronic acid (ZA) on the new bone formation (NBF) after the insertion of a titanium dental implant, which is very popular treatment in dentistry.

STUDY DESIGN

Twelve New Zealand white rabbits were used in this study. The rabbits were divided in two groups. ZA was systemically administered to the study group. Titanium implants were placed to the left and right tibias of the rabbits.

RESULTS

The data from the ZA group revealed a statistically significant increase in the bone mineral content and the bone mineral density. A non-decalcified histomorphometric examination conducted on the study group revealed a significant increase of NBF and bone-implant contact (BIC) at 2 and 4 weeks.

CONCLUSION

A single dose of systemic ZA administration increases the rate of NBF and augments the quality of the bone.