Investigation of the relationship between volume and mortality for surgical procedures performed in New York State hospitals

Recent studies have demonstrated that the number of times a hospital or surgeon performs certain procedures annually has an inverse relationship with in-hospital mortality rates for patients undergoing the procedures. This study uses an improved measure of physician volume to test the combined relationship of hospital and physician volume with in-hospital mortality rates and to explore the existence of threshold volumes that optimally discriminate high- and low-volume providers. Five procedure groups have significant volume-mortality relationships. For total cholecystectomies, hospital volume is the more significant volume measure, but physician volume is marginally related to mortality rate. For coronary artery bypass surgeries, resection of abdominal aortic aneurysms, partial gastrectomies, and colectomies, physician volume is more significant than hospital volume, but hospital volume is marginally significant. Annual hospital volume thresholds for these data appear to exist at approximately 5 procedures for partial gastrectomies, 40 procedures for colectomies, and 170 procedures for total cholecystectomies.

Biofortification and localization of zinc in wheat grain

Zinc (Zn) deficiency associated with low dietary intake is a well-documented public health problem, resulting in serious health and socioeconomic problems. Field experiments were conducted with wheat to test the role of both soil and foliar application of ZnSO4 in Zn concentration of whole grain and grain fractions (e.g., bran, embryo and endosperm) in 3 locations. Foliar application of ZnSO4 was realized at different growth stages (e.g., stem elongation, boot, milk, dough stages) to study the effect of timing of foliar Zn application on grain Zn concentration. The rate of foliar Zn application at each growth stage was 4 kg of ZnSO4·7H2O ha(-1). Laser ablation (LA)-ICP-MS was used to follow the localization of Zn within grain. Soil Zn application at a rate of 50 kg of ZnSO4·7H2O ha(-1) was effective in increasing grain Zn concentration in the Zn-deficient location, but not in the locations without soil Zn deficiency. In all locations, foliar application of Zn significantly increased Zn concentration in whole grain and in each grain fraction, particularly in the case of high soil N fertilization. In Zn-deficient location, grain Zn concentration increased from 11 mg kg(-1) to 22 mg kg(-1) with foliar Zn application and to 27 mg kg(-1) with a combined application of ZnSO4 to soil and foliar. In locations without soil Zn deficiency, combination of high N application with two times foliar Zn application (e.g., at the booting and milk stages) increased grain Zn concentration, on average, from 28 mg kg(-1) to 58 mg kg(-1). Both ICP-OES and LA-ICP-MS data showed that the increase in Zn concentration of whole grain and grain fractions was pronounced when Zn was sprayed at the late growth stage (e.g., milk and dough). LA-ICP-MS data also indicated that Zn was transported into endosperm through the crease phloem. To our knowledge, this is the first study to show that the timing of foliar Zn application is of great importance in increasing grain Zn in wheat, especially in the endosperm part that is the predominant grain fraction consumed in many countries. Providing a large pool of Zn in vegetative tissues during the grain filling (e.g., via foliar Zn spray) is an important practice to increase grain Zn and contribute to human nutrition.

Structural basis of TRPV5 channel inhibition by econazole revealed by cryo-EM

The transient receptor potential vanilloid 5 (TRPV5) channel is a member of the transient receptor potential (TRP) channel family, which is highly selective for Ca2+, that is present primarily at the apical membrane of distal tubule epithelial cells in the kidney and plays a key role in Ca2+ reabsorption. Here we present the structure of the full-length rabbit TRPV5 channel as determined using cryo-EM in complex with its inhibitor econazole. This structure reveals that econazole resides in a hydrophobic pocket analogous to that occupied by phosphatidylinositides and vanilloids in TRPV1, thus suggesting conserved mechanisms for ligand recognition and lipid binding among TRPV channels. The econazole-bound TRPV5 structure adopts a closed conformation with a distinct lower gate that occludes Ca2+ permeation through the channel. Structural comparisons between TRPV5 and other TRPV channels, complemented with molecular dynamics (MD) simulations of the econazole-bound TRPV5 structure, allowed us to gain mechanistic insight into TRPV5 channel inhibition by small molecules.

Inhibition of Transient Receptor Potential Melastatin 3 ion channels by G-protein βγ subunits

Transient receptor potential melastatin 3 (TRPM3) channels are activated by heat, and chemical ligands such as pregnenolone sulphate (PregS) and CIM0216. Here, we show that activation of receptors coupled to heterotrimeric Gi/o proteins inhibits TRPM3 channels. This inhibition was alleviated by co-expression of proteins that bind the βγ subunits of heterotrimeric G-proteins (Gβγ). Co-expression of Gβγ, but not constitutively active Gαi or Gαo, inhibited TRPM3 currents. TRPM3 co-immunoprecipitated with Gβ, and purified Gβγ proteins applied to excised inside-out patches inhibited TRPM3 currents, indicating a direct effect. Baclofen and somatostatin, agonists of Gi-coupled receptors, inhibited Ca²⁺ signals induced by PregS and CIM0216 in mouse dorsal root ganglion (DRG) neurons. The GABA_B receptor agonist baclofen also inhibited inward currents induced by CIM0216 in DRG neurons, and nocifensive responses elicited by this TRPM3 agonist in mice. Our data uncover a novel signaling mechanism regulating TRPM3 channels.

DOI:http://dx.doi.org/10.7554/eLife.26147.001

Simultaneous Biofortification of Wheat with Zinc, Iodine, Selenium, and Iron through Foliar Treatment of a Micronutrient Cocktail in Six Countries

Field experiments were conducted on wheat to study the effects of foliar-applied iodine(I) alone, Zn (zinc) alone, and a micronutrient cocktail solution containing I, Zn, Se (selenium), and Fe (iron) on grain yield and grain concentrations of micronutrients. Plants were grown over 2 years in China, India, Mexico, Pakistan, South Africa, and Turkey. Grain-Zn was increased from 28.6 mg kg^-1 to 46.0 mg^-1 kg with Zn-spray and 47.1 mg^-1 kg with micronutrient cocktail spray. Foliar-applied I and micronutrient cocktail increased grain I from 24 μg kg^-1 to 361 μg kg^-1 and 249 μg kg^-1, respectively. Micronutrient cocktail also increased grain-Se from 90 μg kg^-1 to 338 μg kg^-1 in all countries. Average increase in grain-Fe by micronutrient cocktail solution was about 12%. The results obtained demonstrated that foliar application of a cocktail micronutrient solution represents an effective strategy to biofortify wheat simultaneously with Zn, I, Se and partly with Fe without yield trade-off in wheat.

High prevalence of abdominal aortic aneurysm in patients with three-vessel coronary artery disease

OBJECTIVES

Currently, the prevalence of abdominal aortic aneurysm (AAA) in patients with coronary artery disease (CAD) and the correlation between CAD severity and AAA prevalence are not clearly known. We conducted a prospective study to determine the prevalence of AAA in patients undergoing coronary angiography and to determine the risk factors and a coronary profile associated with AAA.

METHODS

Over an 18-month period, abdominal aortic ultrasound was performed on 1,000 patients undergoing coronary angiography for suspected or known CAD, or prior to valve surgery. Clinical characteristics and coronary profile were collected from the patients.

RESULTS

The overall number of previously repaired, already diagnosed, and new cases of AAA in the study population was 42, yielding a prevalence of 4.2%. Among the patients with newly detected AAAs, only two had an AAA diameter of >54 mm and were therefore treated surgically. In men aged ≥ 65 years, the prevalence reached 8.6%, while in men with three-vessel CAD it was 14.4%. Multivariate analysis showed that age ≥ 65 years (p = .003), male gender (p = .003), family history of AAA (p = .01), current smoking (p = .002), and three-vessel CAD (p < .001) were significantly associated with a higher prevalence of AAA.

CONCLUSION

The prevalence of AAA was high in men aged ≥ 65 years and in those with three-vessel CAD regardless of age. While our findings do not prove the cost-effectiveness of screening for AAA in these high risk patients, they do support the usefulness of a quick ultrasound examination of the abdominal aorta during routine transthoracic echocardiography in such patients.

Ion Channel Sensing: Are Fluctuations the Crux of the Matter?

The nonselective cation channel TRPV1 is responsible for transducing noxious stimuli into action potentials propagating through peripheral nerves. It is activated by temperatures greater than 43 °C, while remaining completely nonconductive at temperatures lower than this threshold. The origin of this sharp response, which makes TRPV1 a biological temperature sensor, is not understood. Here we used molecular dynamics simulations and free energy calculations to characterize the molecular determinants of the transition between nonconductive and conductive states. We found that hydration of the pore and thus ion permeation depends critically on the polar character of its molecular surface: in this narrow hydrophobic enclosure, the motion of a polar side-chain is sufficient to stabilize either the dry or wet state. The conformation of this side-chain is in turn coupled to the hydration state of four peripheral cavities, which undergo a dewetting transition at the activation temperature.

Natural-based Antibiofilm and Antimicrobial Peptides from Microorganisms

As the resistance to antimicrobial molecules increases among bacteria, the need for new antimicrobial molecules increases. Antimicrobial peptides (AMP), which may be a new generation of antibiotic candidates, are important in this respect. AMPs are small, cationic and amphipathic peptide sequences. In eukaryotes, they are synthesized as a part of the immune system. Substantially, AMPs are discovered in all kingdoms of life such as bacteria, fungi and protozoa. Approximately 3,000 AMPs have been reported in the literature. However, most of these AMPs have been synthesized through chemical synthesis. Nature has a huge source of microorganisms, and in the literature, there is a tendency to increase every year the number of bacteria and fungus-derived AMPs thanks to their biotechnological importance. The exploration of AMP and antibiofilm peptide (ABP) producer microorganisms brings with it a lot of challenges experimentally. In this review study, we want to highlight the importance and challenge of these natural peptides derived from microorganisms. We will also propose a new explanation for ABPs.

Factors influencing central corneal thickness in a Turkish population

PURPOSE

The aim of this study is to find out the central corneal thickness (CCT) values for a Turkish patient group and to investigate the possible influences of age, sex, IOP, refractive status, keratometry readings, systemic disorders (hypertension, diabetes mellitus, hyperlipidemia, heart disease and asthma) on CCT values.

MATERIALS AND METHODS

Six hundred twenty five subjects (276 male (44%), 349 female (56%)) of ages 6 to 88 years were recruited. Subjects who had corneal diseases, purulent conjunctivitis or blepharitis were excluded. Refraction and keratometry readings were made by MRK-3100 premium auto-ref/keratometer, IOP was measured by Reichert AT-555 auto noncontact pneumotonometer.

RESULTS

Mean age was 44.1 +/- 16.6 years +/- SD for male subjects, 41.0 +/- 16.9 for females. Mean CCT +/- SD values for male was 552.2 +/- 35.9 microm, for female was 552.3 +/- 35.4 microm, respectively. There was no significant difference between right and left eye CCT values for both genders. Age and CCT was not correlated for the whole study group but there was a slight negative correlation in male subjects. IOP and CCT had moderately significant correlation for males and females. There was a slight significant correlation between Kh-Kv and CCT values for the whole group. In a multivariate regression model only Kv values seemed to affect CCT values.

DISCUSSION

There are studies showing the variation of CCT values among different nations and ethnicities. There is no agreement about the relationship between age, IOP, Kh-Kv, spherical equivalence of refractive error, systemic disorders, menopause and CCT. In our study CCT was correlated with Kh-Kv and IOP in correlation analysis but in multivariate regression analysis only Kv appeared to influence corneal thickness.

A new approach for the treatment of recurrent large abdominal hernias: the overlap flap

In this article we report a new technique for the treatment of recurrent large abdominal hernias and skin laxity: the overlap flap. This technique combines abdominoplasty with hernia repair. Obese patients with recurrent large abdominal hernias and skin laxity could benefit from this operation. This operation could not be performed in patients with a wide absence of the abdominal wall. A total of six patients were treated with this technique in our clinic. Follow-up of the patients has ranged from 1 to 4 years. Cosmetic results were excellent in all patients. No recurrence of the hernias has been observed in any of the patients. Two flaps are prepared; the lower one is deepithelialized, and it is used as an autogenous mesh in place of a prosthetic material to reinforce the abdominal wall, and the upper flap is prepared and overlapped on this lower one.

ING5 inhibits cancer aggressiveness by inhibiting Akt and activating p53 in prostate cancer

Prostate cancer (PCa) is one of the most common types of cancer in men. In several recent studies, chromosomal deletions in the q arm of chromosome 2, where ING5 resides within, have been identified in various cancer types including PCa. In this study, we investigate the role of ING5 as a tumor suppressor in PCa. We examined the expression level of ING5 in tissue samples and cell lines using quantitative real-time polymerase chain reaction and western blot analysis. We tested the in vitro tumor suppressor potential of ING5 in PC3 and LNCaP cells stably overexpressing it using cell viability, colony formation, migration, invasion, and apoptosis assays. We then investigated the effects of ING5 on the Akt and p53 signaling using western blot analysis. We show that ING5 is significantly downregulated in PCa tumor tissue samples and cell lines compared with the corresponding controls. In vitro assays demonstrate that ING5 effectively suppresses proliferative, clonogenic, migratory, and invasive potential and induce apoptosis in PCa cells. ING5 may potentially exert its anti-tumor potential by inhibiting AKT and inducing p53 signaling pathways. Our findings demonstrate that ING5 possesses tumor suppressor roles in vitro, pointing its importance during the prostatic carcinogenesis processes.

Factors Affecting Intraocular Pressure Measured by Noncontact Tonometer

Purpose

To investigate the mean values of intraocular pressure (IOP) measured with non-contact tonometer (NCT) and evaluate the factors that may affect IOP.

Methods

A total of 850 subjects who were admitted to our clinic between March 2005 and February 2006 were recruited for the study. Subjects having blepharitis, conjunctivitis, corneal diseases, glaucoma suspicion, or glaucoma were not accepted to the study. All subjects were questioned about systemic diseases. IOP measurement with NCT and central corneal thickness (CCT) with ultrasound pachymetry were performed for each patient between 9 and 11 AM.

Results

The mean ages of 367 (43.2%) male subjects and 483 (56.8%) female subjects were 43.9±18.1 and 40.7±18.0 years ± SD, respectively. Since right and left eye IOP, CCT, and keratometric values were significantly correlated, right eye values were used for statistical purposes. Mean IOP values in males and females were 13.2±3.0 and 13.5±2.9 mmHg, respectively. Mean CCT values were 552.5±34.7 μm for males and 550.1±34.3 μm for females. In multiple regression analysis, IOP was found to be associated with gender, refractive error, CCT, and the presence of diabetes mellitus (DM).

Conclusions

Gender, CCT, the presence of DM, and refractive error may be significantly associated with IOP in this particular population.

MicroRNA-145 transcriptionally regulates Semaphorin 3A expression in prostate cancer cells

Prostate cancer (PCa) is one of the most prevalent cancer types among males. Differential expression of microRNAs is associated with various cancers including PCa. Although mature microRNAs are preferentially located in the cytoplasm, several studies identified mature human microRNAs in purified nuclei and miR-145 has been found to be predominantly expressed in the nuclei of benign tissues compared to tumor lesions. However, the nuclear functions of miR-145 are yet limited. Here, we aimed at investigating the inductive role of miR-145 on the expression of Semaphorin 3A (SEMA3A) in PCa cell lines. To study the regulatory potential of miR-145 in the transcriptional level in PCa, we overexpressed miR-145 in PC3 and DU145 cells, and confirmed its upregulation by quantitative-real-time-PCR. Then we investigated the tumor suppressor potential of miR-145 upon inducing SEMA3A expression using cell viability assay, western blot analysis, Chromatin Immunoprecipitation assay and luciferase reporter assay. Our results revealed that p53, miR-145, and SEMA3A expressions are significantly downregulated in PC3 and DU145 cells compared to nontumorigenic prostate epithelial PNT1a cells. miR-145 overexpression in PCa cells induced the expression of SEMA3A at both messenger RNA and protein levels. Furthermore, increased miR-145 expression enriched RNA Pol-II antibody on the promoter of SEMA3A and induced luciferase activity controlled by SEMA3A promoter. In this study, we showed that the functions of miR-145 are not limited to gene silencing, and found that it may lead to changes in gene expression in the transcriptional level.

The correlation of computed tomography in the evaluation of septoplasty patients

Background

Septoplasty is one of the frequently applied nasal surgical procedures. There is still no gold standart objective method to evaluate the patients whom suffers from nasal blockage. To evaluate the septoplasty candidate with a Paranasal Computerised Tomography (PNCT) is one of the most discussed topic in the otorhinolaryngology surgical philosophy.

Objectives

In this study, we aim to interpret the value of nasal valve areas measured by PNCT for both septoplasty candidates and the control population. We believe that this information could be useful for the evaluation of patients before undergoing a septoplasty procedure.

Material and Methods

600 coronal and axial tomography sections performed between May 2014 and February 2018 at the University Of Gaziantep Radiology Dept. were assessed. These tomography sections were divided into two groups called the septoplasty and the control. The septoplasty group was made up of three hundred paranasal sinus tomography images scanned before patients' septoplasty operations. The control group was created by screening 300 maxillofacial tomography's which were taken due to the suspicion of trauma at the University Of Gaziantep Emergency Clinic between May 2014 and January 2018.

Results

There were 192 (64%) patients with left nasal septal deviation and 108 (36%) patients with right nasal septal deviation. The Independent Sample T-Test revealed that the mean internal nasal valve angle in the left septoplasty group was significantly lower than that of the control group (P < 0.005). A comparison of the right side nasal values revealed a significant statistical change according to the Independent Sample T-Test between the value of the right septoplasty and the control groups (P < 0.005).

Conclusion

The sectional areas of nasal tomography images may show different values. However, it is still difficult to say that the clinical application of tomography images could be used as one of the indication criteria for the septoplasty procedure.

FRI0473 ASSESSMENT OF FEMORAL VEIN WALL THICKNESS WITH DOPPLER US AS A DIAGNOSTIC TOOL FOR BEHCET’S DISEASE

Background:

Diagnosing Behcet’s disease(BD) is a challenge, especially in countries with a low prevalence. International Study Group Criteria, accepted to as diagnostic, has low sensitivity, especially in early cases when major organ involvement such as uveitis or deep vein thrombosis(DVT) presents alone. We recently published a controlled study of assessing venous wall thickness(VWT) as a surrogate marker of venous disease in BD with ultrasound(US) and observed a very sensitive and specific VWT in male BD patients. The common femoral vein(CFV) thickness measurement, as the primary site of US with the cut-off values > 0.48-0.49 mm, had a high area under the receiver operating characteristic curve(>0.8) with sensitivity and specificity of around 80%(1).

Objectives:

In this study, we aimed to investigate the diagnostic performance of CVF thickness measurement in BD including females comparing with multiple control disease groups.

Methods:

One hundred-ten patients with BD, 47 healthy controls(HC), 21 patients with systemic vasculitides, 28 patients with venous insufficiency,29 patients with antiphospholipid syndrome (APS) having DVT history, were included the study.Bilateral CFV thickness was measured with US by an experienced radiologist blinded to cases(Figure 1).

Figure 1.

Measurement of common femoral vein thickness

Results:

Bilateral CFV thickness was significantly higher in BD compared to all comparative groups (p<0.001 for all)(Table 1,Figure 2). No correlations were present between CFV thickness and both BSAS and CRP levels (p>0.05 for all). In only 2 (8%) patients with venous insufficiency and 2 (10%) patients with systemic vasculitis, bilateral CVF thickness was higher than the cut- off values. Interestingly, APS was the only control group with positivity, in 12 (41%) patients with APS, bilateral CFV thickness was higher than the cut-offs. There was no difference between male vs female BD patients regarding CFV thickness (right CFV:0.78 mm vs 0.79 mm,p=0.96, left CFV:0.78 vs 0.8, p=0.80). Although a higher CVF thickness tendency was observed in VBD, no statistically significant difference was present between BD patients with (n=40) and without (n=58) vascular involvement (right CFV:0.82±0.3 mm vs 0.75±0.3 mm, p=0.122, left CFV:0.84 ± 0.3 vs 0.76±0.3, p=0.165).

Table 1.

Venous Wall Measurements of Lower Extremity in Study Groups

Behcet’s Disease(n=110)Healthy Controls(n=47)Systemic Vasculitis(n=21)Venous Insufficiency(n=28)Anti-phospholipid Syndrome with DVT (n=29)Age (years)33.5 ± 630.1 ± 533.3 ± 736.7 ± 638.3± 9Gender, malen (%)89 (81)40 (85)12 (57)13 (46)9 (31)Body MassIndex, kg/m225.5 ± 424 ± 223.8 ± 3.527.7 ± 427.2 ± 7Right CFVThickness (mm)0.79 ± 0.30.34 ± 0.10.34 ± 0.150.38± 0.10.48 ± 0.15Left CFVThickness (mm)0.78 ± 0.30.3 ± 0.10.36 ± 0.140.38 ± 0.20.48 ± 0.15

CFV: Common Femoral vein, DVT:Deep Venous Thrombosis

Figure 2.

Distribution of common femoral vein thickness in study groups

Conclusion:

Increased CFV thickness is present in BD patients,independent of vascular involvement.We also found that CFV thickness is a distinctive feature of BD, rarely present in other inflammatory/vascular diseases such as ankylosing spondylitis (previously shown),systemic vasculitides and venous insufficiency(except APS with DVT).CFV thicknesses are easily and reliably measured by Doppler US. We, therefore, suggest that assessment of CFV can be a diagnostic tool for BD with a good sensitivity and specificity to differentiate BD from similar disorders.

References:

[1]Alibaz-Oner et al.Clinical Rheumatology (2019)38:1447–51.

Disclosure of Interests:

None declared

AB0439 LUNG FINDINGS IN PATIENTS WITH PRIMARY SJOGREN’S SYNDROME

Background:

Sjogren’s syndrome (SS) is a systemic, autoimmune disease and can affect many organs and systems.

Objectives:

In this study, we planned to present the lung findings of primary SS (pSS) patients who are being followed in our outpatient clinic.

Methods:

Chest radiographs and thorax CTs of 151 patients who were admitted to the rheumatology outpatient clinic between 2004 and 2017 and diagnosed as pSS according to the classification criteria of the American-European consensus group Sjogren’s syndrome were retrospectively scanned.

Results:

In our study, 97% of pSS patients were female and 3% were male and the mean age was 56 ± 12 years, disease duration was 10.5 ± 5 years.

It was observed dry eye in 86% of patients, dry mouth in 88%, parotitis in 17%, arthritis in 29%, vasculitis in 4%, neuropathy in 6%, myositis in 1%, lymphadenopathy in 29% (LAP), and 20% of patients had Raynaud phenomenon. In 50% of the patients, chest radiography was normal, and there were no respiratory complaints. Thorax CT was requested due to suspicious appearance on 50% chest x-ray.

According to CT findings, 23% had nodules in the lung, nodule sizes were less than 1 cm, and patients were followed up for an increase in size. Hiler and subcarinal lymph nodes were present in 6% of patients and their sizes was ranged from 5 mm to 15 mm. Bronchoscopy was performed for two patients due to mediastinal LAP. Biopsy results were evaluated as reactive changes.

Interstitial lung disease (ILD) findings were present in 16 patients. (69% NSIP, 25% LIP, 6% UIP). All patients with ILD received steroid therapy. Two patients received 6 cycles of cyclophosphamide treatment for active alveolitis and azathioprine (AZA) was used in maintenance therapy. Due to ILD, one patient was receiving rituksimab, one patient was receiving mycophenolate mofetil, while nine patients were using AZA.

It was found bronchiectasis in 3% of patients, emphysema in 5%, sequelae fibrotic changes in 13%, and 1% patients had thickening of the pleura. One patient was diagnosed with hypersensitivity pneumonia and two patients had lung cancer (Table-1).

There was a smoking history in 21% of the patients. There was a significant relationship between smoking and development of emphysema and malignancy. The relationship between smoking and lung cancer development could not be assessed due to the absence of lung cancer in the non-smoking group (Table-2).

Conclusion:

Lung findings are detected in 9-12% of patients in pSS, which can increase to 75% with the use of tomography, pulmonary function tests and bronchoscopy.

Since pSS has a wide spectrum from airway disease or interstitial lung disease to BALT lymphoma lung involvement of the disease has been emphasized.

References:

[1]Hatron PY, Tillie-Leblond I, Launay D, et al.: Pulmonary manifestations of Sjogren’s syndrome. Presse Med. 40:e49-e64 2011

Table 1.

Lung Findings of Primary Sjogren’s Syndrome Patients

%(N)Nodule23(34)Mediastinal LAP9(6)Interstitial Lung Disease11(16)NSIP69(11)LIP25(4)UIP6(1)Bronchiectasis3(4)Atelectasis5(7)Emphysema5(7)Sequelae Fibrotic Change13(19)Tuberculosis Sequelae1(2)Airway disease1(1)Pleural effusion1(2)Lung cancer1(2)Table 2.

Effects of smoking on lung findings

N(%)Smoker31(21)Non-Smoker107(71)pOR%95 CIEmphysema6(19)1(1)0,001252,9-220Interstitial Lung Disease2(7)14(13)0,5240,4580,09-2,13Raynaud6(19)22(21)0,8830,9260,33-2,53LAP10(32)32(30)0,8021,110,47-2,63Nodule9(29)23(22)0,3811,490,60-3,68Malignancy7(23)8(8)0,0433,61,19-10,9Lung Cancer2(7)0---Atelectasis2(7)3(3)0,3132,390,38-14,9Bronchiectasis04(4)---

Disclosure of Interests: :

None declared

The effect of parental consanguinity on the clinical and laboratory findings of rheumatoid arthritis

AIMS

We aimed to evaluate the frequency of consanguinity among the parents of patients with rheumatoid arthritis (RA) and the influence of parental consanguinity on several clinical and laboratory parameters which reflect the severity of the disease.

METHODS AND PATIENTS

The study population consisted of 265 patients with RA which were divided into two groups with respect to the presence or absence of consanguinity between their parents. The frequency of parental consanguinity was compared with the general population. The two groups were compared with respect to family history of RA, the age of onset, the age at which RA was diagnosed, duration of the disease, the presence of rheumatoid nodules, vasculitis, serositis and the need for orthopaedic surgery, amyloidosis, the presence and level of rheumatoid factor and anti-cyclic citrullinated peptide antibodies, erosive changes on radiographs, and the need for anti-tumour necrosis factor therapy.

RESULTS

Twenty-one patients (8%) had parents who were consanguineous, which was not more frequent compared with the general population (14%). The mean age of disease onset and the mean age at which RA was diagnosed were lower in patients with parental consanguinity, although the difference was not statistically significant. The other clinical and laboratory parameters were also not different between the two groups.

CONCLUSION

The present data suggests that parental consanguinity has no effect on disease severity, and the frequency of consanguinity is not increased among the parents of patients with RA. A possible exception is the earlier disease onset and age at diagnosis which needs to be confirmed by larger studies.

AB0362 DEMOGRAPHIC AND CLINICAL CHARACTERISTICS OF BEHCET’S DİSEASE PATIENTS

Background:

Behcet’s Disease (BD) is a systemic variable vessel vasculitis that involves the skin, mucosa, joints, eyes, arteries, veins, nervous system and the gastrointestinal system.

Objectives:

In this study we aimed to present variety of involvements in patients who were followed up in our outpatient clinic with a diagnosis of BD.

Methods:

Data of 394 patients diagnosed with BD between 2000-2020 were retrospectively reviewed clinical, demographic characteristics and systemic involvements.

Results:

In our study 43.7% of BD patients were female, 56.3% were male and the mean age was 40±11years, disease average age of onset 36.5±10.6, disease duration was 12.8±6.8years. It was observed mucocutaneus involvement 98% of the patients, uveitis in 35%, retinal vasculitis in 2.8%, arthritis in 24.9%, arterial occlusion in 2.3%, arterial aneurysm in 3.8%, venous involvement in 19.8%, gastrointestinal (GIS) involvement in 4.3%, cardiac involvement in 1.5%, and cranial involvement 7.1 (Table 1).

Table 1.

The Data of Behçet Disease

n (%)n= 394GenderFemale172 (43.7)Male222 (56.3)Family History48 (12.2)Fever & Weight Loss21 (5.3)Mucocutaneus involvement386 (98)Oral Aphthous Ulcer379 (96.2)Genital Ulcer256 (65)Papulopustular lesions129 (32.7)Erythema Nodosum-like lesions150 (38.1)Skin Pathergy Reaction185 (47)Uveitis138 (35)Retinal Vasculitis11 (2.8)Venous involvement76 (17.6)Thrombophlebitis30 (7.6)67 (17)Deep venous thrombosisArthritis98 (24.9)Monoarthritis74 (75.5)Oligoarthritis21 (21.4)Sacroiliitis3 (3.0)Artery Occlusion9 (2.3)Arterial Aneurysm15 (3.8)GIS involvement17 (4.3)İleum9 (2.3)Colon2 (0.5)Rectum1 (0.3)İleocolonic4 (1)Cardiac involvement6 (1.5)Pericarditis2 (0.5)Ventricular thrombosis3 (0.7)Atrial thrombosis1 (0.2)Cranial involvement24 (5.6)Parenchymal involvement13 (4.6)Cerebral Venous Thrombosis11 (2.8)Pulse steroid15 (3.8)1mg/kg steroid48 (12.2)Infliximab13 (3.3)Azathioprine184 (46.7)Cyclophosphamide31 (7.9)

When all patients evaluated in terms of renal findings, proteinuria was observed in 5 patients and hematuria was observed in 2 patients. 3 patients had proteinuria over than 500mg/day. Their renal biopsy findings; 2 of them were nonspecific involvements and one of them was minimal mesangioproliferative changes.

Conclusion:

As a multi-system disease, general data have been presented, as clinical symptoms involve almost all systems of the body (1).

References:

[1]Behcet’s disease Fereydoun Davatchi 1Int J Rheum Dis.2014 May;17(4):355-7. doi: 10.1111/1756-185X.12378.

Disclosure of Interests:

None declared

AB0665 Turkish validation of the ‘Cochin (Duruoz) hand function scale’ in patients with systemic sclerosis

Background

Hand impairment is the main challenge for patients with systemic sclerosis (SSc) and may arise from inflammatory arthritis, joint contractures, tendon friction rubs (TFRs), Raynaud’s phenomenon (RP), digital ulcers (DU), puffy hands, skin sclerosis, acro-osteolysis, or calcinosis. There is not yet a tool which can objectively measure hand functions in scleroderma patients both in daily practice and for research purposes.

Objectives

To adapt and validate the Turkish version of Cochin (Duruoz) hand function scale (CHFS) and contribute to the development of outcome measures with good metric properties assessing hand disability in SSc (1).

Methods

Ninety one consecutive patients who fulfilled the 2013 ACR/EULAR SSc classification criteria for SSc were enrolled in the study. Disease related involvements and physical examination findings of the patients were recorded. Participants filled out the self-administered questionnaire of the Turkish version of the CHFS. Modified Rodnan skin scores of the patients were calculated, bilateral hand extension and fingertip-palm distances were measured, grip strength was evaluated with hydrolic hand dynamometer. We evaluated convergent validity by testing the correlation between CHFS and related components of Short Form 36 version 2 (SF-36v2) and Scleroderma Health Assessment Questionnaire (sHAQ). Discriminant validity was evaluated by stratifying patients according to hand related involvements and disease subtypes. Thirty of the patients re-filled the CHFS questionnaire two weeks after the first visit.

Results

Demographic data and disease characteristics of the patients shown in Table 1. For the convergent validity, the CHFS significantly correlated with the sHAQ, Raynaud visual analog scale (VAS), digital ulser VAS, overall disease severity VAS, hand grip, hand extension measurements and fingertip-palm distances (Table 2). The instruments could discriminate between disease subtypes (10[0-24] / 2[0-19], p=0,038) and between the patients with and without contractures (11[0-24] / 2[0-9], p=0,023) for the discriminant validity. We demonstrated high reproducibility for CHFS (ICC = 0,894, 95% confidence interval = 0,779-0,949).

Table 1.

Demographic data and disease characteristics of the patients

Age (years)55.4±10.7Total mRSS6 ±5.1Sex (female)79 (%86.8)Right hand total mRSS2.2±1.7Diseasesubtype (diffuse)25(%27.5)Left hand total mRSS2.2±1.7PAH6 (%6.7)Right hand fingertip-palm distance (cm)1.3±1ILD41 (%45.6)Left hand fingertip-palm distance (cm)1.2±1.2ANA positivity88 (%96.7)Right hand extension (cm)17.7±2.5Arthritis1 (%1.1)Left hand extension (cm)18±2.3Sclerodactly79 (%86.8)Right hand hydrolic dynomometer pressure (kg)21.7±8.6Contracture26 (%28.6)Left hand hydrolic dynomometer pressure (kg)20.4±7.6Amputation12 (%13.2)SF 36 physical function51.7 ±24Active digitalulcer3 (%3.2)SF 36 role limitations due to physical health52±42Digitalulcerscar23 (%25.3)SF 36 role limitations due to emotional problems57.3±33.4Calcinosis10 (%11)SF 36 energy/fatigue46±23.3CHFS score3 [0-13]SF 36 emotional well-being60.4±21.2Raynaud’s phenomenon VAS0.8±0.9SF 36 social functioning70±26Digital ulcer VAS0.5±0.9SF 36 pain64±30Overall disease severity VAS0.9±0.9SF 36 general health44.3±21.7

PAH: Pulmoner arterial hypertension, ILD: Interstitial lung disease, ANA: Anti nuclear antibody, CHFS: Cochin hand function scale, mRSS: Modified Rodnan skin score, VAS: visual analog scale, SF36: short form 36

Conclusion

The Turkish version of the CHFS met the requirements of validity and reproducibility. With this study, we validated a scale which will contribute to the development of outcome measures with good metric properties assessing hand disability, disease evolution and treatment efficacy in our SSc patients.

References

[1]Duruöz MT, Poiraudeau S, Fermanian J, et al. Development andvalidationof a rheumatoid hand functional disability scale that assesses functional handicap. J Rheumatol. 1996;23(7):1167-1172.

Disclosure of Interests

None declared