Borderline Values Research Articles

P1687 When the easiest answer is the right one

Abstract A 42 year-old woman presented with moderate exertion dyspnea within the past months. She was hypertensive, with end stage-chronic kidney disease (CKD) on hemodialysis for 8 years, initially by arteriovenous fistula and then by central venous catheter. She associated thrombosis of both common femoral veins. Clinical examination revealed mild leg edema, hepatomegaly, III/VI systolic murmur, left brachiocephalic arteriovenous fistula with aneurismal dilation and subclavian central venous catheter. Resting ECG showed atrial flutter with variable block and biventricular hypertrophy. Lab studies highlighted mild anemia, glomerular filtration rate (MDRD) 13.5 ml/min/1.73m2, hyperhomocysteinemia. Transthoracic echocardiography revealed left ventricle (LV) with normal diameters and mild concentric hypertrophy, mild systolic LV dysfunction and diastolic dysfunction (Fig A), dilation of both atria, mild mitral regurgitation, dilated RV with moderate global dysfunction, moderate tricuspid regurgitation and secondary pulmonary hypertension (PH) with estimated systolic pulmonary artery pressure of 79 mmHg (Fig C), moderate pulmonary regurgitation, moderate dilatation of pulmonary artery. Vascular Doppler ultrasonography showed thrombosis of the arteriovenous fistula and of right jugular vein. To confirm PH, right heart catheterization was necessary. The intervention could not be realized on femoral approach due to thrombosis of both common femoral veins. We considered the jugular approach, but weighing the risks/benefits balance, with one functional jugular vein, we decided not going for it, as the jugular approach was the only vascular approach for dialysis. We performed left catheterization right after a dialysis session and an LV end-diastolic pressure of 13 mmHg was measured. The possible causes of PH considered in this case were the CKD by itself, a pulmonary thromboembolic component in a patient with hyperhomocisteinemia and thrombosis of both femoral veins and a left heart component given the borderline value of LV end-diastolic pressure. The patient received treatment with beta-blockers, blockers of the renin-angiotenins-aldosterone system, calcium channel blockers and oral anticoagulation. She was evaluated after two months describing improvement of symptoms. The resting ECG showed sinus rhythm and the echocardiography revealed improved parameters of LV diastolic function (Fig B), with reduction of systolic pulmonary artery pressure (Fig D) and improvement of right heart parameters. PH is a frequent complication in patients with CKD on hemodialysis. Possible mechanism of its development include RV overload with increased pulmonary flow or creating a fistula with an increased flow through arteriovenous shunt. Thromboembolic complications and hyperhomocysteinemia are other frequent findings in these patients. Despite all the above, the left heart involvement with LV diastolic dysfunction remains a common and amendable cause of PH in this setting. Abstract P1687 Figure.

Continuity of weak solutions to nonlinear fourth-order equations with strengthened ellipticity via Wolff potentials

In the present article nonlinear fourth-order equations in the divergence form with L^1-right-hand sides and the strengthened ellipticity condition on the coefficients are analyzed. Such equations, but with sufficiently regular right-hand sides, first appeared in the works of Professor I.V. Skrypnik concerning the regularity of generalized solutions for multidimensional nonlinear elliptic equations of high order. This class of equations correctly generalizes the corresponding nonlinear second-order elliptic equations with non-standard growth conditions on the coefficients, which are models for numerous physical phenomena in non-homogeneous medium. The main result of the article is a theorem on an estimation of oscillations in a ball of solutions to the given equations via the Wolff potentials of their right-hand sides. To prove this, we use the improved Kilpelainen-Maly method and pointwise potential estimates of functions related to special subclasses of Sobolev spaces, akin to the well-known De Giorgi classes. A new point is the verification that these classes contain superpositions of solutions and Moser logarithmic functions that include the Wolf potential of the right-hand side of the equation. As a corollary, a new result is obtained on the interior continuity of solutions to the equations with right-hand sides from the Kato class, which is characterized by the uniform convergence to zero of the corresponding Wolff potentials. Some important cases of fulfilling this condition are considered: the right-hand side of the equation belongs to the Morrey space with an index exceeding a certain limiting value, then the solutions are locally Holder continuous; if the right-hand side belongs to the borderline Lorentz-Zygmund classes, then the solutions are only locally continuous, but they are not Holder continuous in the domain. In the case when the summability exponents of the right-hand sides of the equations under consideration are less than the borderline values, there are examples of unbounded discontinuous solutions. These facts are exact analogues of the corresponding results in the theory of second-order elliptic equations.

Clinical and epidemiological characteristics of hepatic cirrhosis of hepatitis C virus etiology in the early stages of its formation

Background. Currently, the incidence of viral cirrhosis of the liver increases significantly, presenting an essential medical and social problem. This study aimed to clarify the clinical and epidemiological characteristics of hepatic cirrhosis of hepatitis C virus (HCV) etiology in the early stages of formation to improve the quality of diagnosis using a sample of patients from the regional hepatological center in Krasnodar (Specialized Clinical Infectious Diseases Hospital).
 Methods. In 2018, 1,307 patients with liver diseases of viral etiology were examined and treated at the hepatological center. A retrospective analysis of the monitoring results of 153 patients with hepatic cirrhosis of viral C etiology with HCV replication was performed; patients with mixed etiology of cirrhosis were excluded from the study. The enrolled participants included 89 women (58.2%) and 64 men (41.8%). The average age of the patients was 53.5 0.93 years. In accordance with the ChildPugh classification of hepatic cirrhosis, class A (I) was diagnosed in 92 (60.1%) patients, and class B (II) was revealed in 53 (34.6%) patients.
 Results. In 59.5% of cases, viral liver damage was first detected at the stage of outcome to cirrhosis. In 1/3 (32.5%) of the patients, the diagnosis of hepatic cirrhosis was established in the year of visit, and in another 27%, it was established during the first three years from the date of detection of hepatitis C markers. In less than in 1/5 (18.3%) of the patients, 924 years have passed from the discovery of hepatitis C markers to the establishment of hepatic cirrhosis. During the three-year follow-up period, the progression of cirrhosis with the transition to the next stage occurred in 6.5% of cases. In residents of Krasnodar Territory, among the leading epidemiological factors, including a monofactor epidemiological history and multifactorial nature with almost the same frequency, the alleged cause of infection was surgery (43%45%). Prosthetics, dental sanitation, and blood transfusion were indicated as possible infection factors with high incidence. Factors, such as drug addiction, childbirth, tattoos, occupational injuries in medical personnel, and abortions, were recorded in isolated cases. In the early diagnostics of compensated class A cirrhosis, the increased contents of alanine and aspartate aminotransferases showed diagnostic value. Mild increases in the levels of alpha-fetoprotein and direct bilirubin, moderate decreases in prothrombin index and platelets, dilation in the diameter of the portal (v. portae) and splenic (v. lienalis) veins to borderline values with an upper limit of norm with an increased size of the spleen, and esophageal varices, and development of the initial stage of hepatic encephalopathy were also noted. The presence of extrahepatic manifestations in 12% of the patients should be considered.
 Conclusion. Despite the high infection rate of the population with hepatitis C virus, late diagnostics of liver damage often occurred, and this finding is partly due to the late action of patients in seeking medical help. On the other hand, the widespread introduction of mandatory medical examination led to the active identification of sick people. For timely diagnosis, the presence of a history of risk factors for hepatitis infection must be considered, and attention must be focused on the abnormalities of blood biochemical parameters, ultrasound, and fibrogastroduodenoscopy data.

Thyroid stimulating hormone values of clinical decisions of hypothyroidism measurement by three different automated immunoassays

Background: An accurate measurement of serum thyroid stimulating hormone (TSH) is crucial for a thyroid disorder diagnosis and management. We compared the values of TSH between three automated immunoassays with aims to provide insights into variations in TSH levels that are important for a clinical decision: 2.50 mIU/L, 4.00 mIU/L and 10.00 mIU/L.Methods: We measured TSH with three different fully automated immunoassays: Abbott (Architect ci8200), Siemens (ADVIA Centaur XP) and Roche (Cobas e411). Serum was collected from 110 patients between August 2018 and January 2019. The results were compared using the Passing–Bablok regression method. Additionally, linear regression coefficients were calculated after logarithmic transformation of data.Results: Although all three regression coefficients were high (r2 > 0.98), the slopes from Passing–Bablok plots for the correlation of Abbott with either Roche or Siemens were merely 0.66 and 0.73, respectively. The slope for the correlation of Roche and Siemens was 1.11. Consecutively, the results obtained by the Roche and Siemens methods were proportionally higher than those obtained by the Abbott method (38% and 52%, respectively) at all measured ranges.Conclusions: Although immunoassays correlated among themselves, they cannot achieve the same values for clinical decisions for hypothyroidism (clinical requirements). Clinicians should be conscious of these limitations. A harmonisation of the methods is needed to meet clinical requirements and to enable appropriate clinical decisions in cases of hypothyroidism.Likewise, we suggest the introduction of borderline and high risk values of TSH for hypothyroidism depending on immunoassays to avoid misdiagnosis.

Secondary Autoimmune Neutropenia: Data from the Italian Neutropenia Registry

Background Autoimmune neutropenia is a chronic reduction of absolute neutrophil below the threshold for age, due to peripheral destruction by specific antibodies (AaN). "Primary autoimmune neutropenia" (pAN) usually appears in early infancy and generally resolve within 18-24 months, while "Secondary autoimmune Neutropenia" (sAN) rises later in life and is usually accompanied by autoimmune features. Very few descriptions on the topic are available in the literature. Aim of the study: to describe from a clinical and immunological point of view a cohort of subjects affected with sAN included registered in the Italian Neutropenia Registry (INR) and to compare these data with those from subjects diagnosed with pAN still in the INR . Patient and methods Subjects with neutropenia and positivity of AaN lasting for more than 2 years in subjects older than 5 years of life ( up to 18) or patients affected with neutropenia (plus AaN) associated with autoimmune features registered in the INR from 2005 to 2018 were considered eligible for the present study. Antibodies against neutrophils were always detected throught indirect test . Results: Data from 40 patients affected with sAN (26 females, 65%) were collected. Median age at diagnosis was of 11.6 years (0-21.558mo) with a median follow up of 17 months (0-159mo). The degree of Neutropenia was mild in 12.5%(5/40), moderate in 35% (14/40) and severe in 52.5% (21/40) Neutropenia was diagnosed by chance in half of the cohort and in only 10% (4/40) (10%) definitively resolved . Neutropenia coexisted with leucopenia in almost all the of subjects (36/40, 88%), and moreover, autoimmune haemolytic anemia and thrombocytopenia was concomitant to neutropenia in 12% (5/40) and 32.5% in (13/40) of cases respectively. As for clinical history, 15% (6/40) subjects (15%) were completely asymptomatic , while the remaining 85% (36/40) (85%) had clinical signs of infections and/or autoimmunity features . Infections were documented in 60% (24/40) (60%) of patients. Severe infections namely sepsis , meningitis, pneumonia, osteomyielitis and broad absesses/flemmons were identified in 21% (5/24) of the group. Other type of infections are listed Figure 1A. Apparently there was no correlation between severity of infections and degree of neutropenia ( p=0.2 Fisher' exact test) Autoimmune features and/or autoimmunity markers were present in 30/40 (75% ) of the entire cohort . Thyroiditis and artralgia/arthritis were the most common signs which accounted both for 17,5% of the total episodes. Positivity of ANA and Direct antibodies test ( DAT) were showed in 42% and 29% of cases respectively. (Fig 1B, 1C) As for immunological characteristic 37% (12/32) of the studied subjects were frankly lymphocytopenic, 19% (6/32) had borderline values , while the remaining 44% (14/32) had normal lymphocytes subclasses. In terms of frequency of sub-classes depletion CD19 + and NK were the most frequently decreased subsets. ( Fig 1D) . Dosage of serum immunoglobulin (IgG, IgM and IgA) were shown for all three classes were abnormal (either increased or diminished) in 74% (28/38) of patients (Fig 1D). Mutation analysis performed by Next Generation Sequencing in 16/40 subjects and pathogenic variants of : TACI, TINF 2, CASP 8, CASP 10, PI3K, CARD 11 genes were identified in 4/16 (25%). As for treatment, in 25 % of cases needed Granulocyte-Colony Stimulating Factor to control infections. Rapamicin, micophenolate mofetil, steroids, intravenous immunoglobulin were necessary in 25% (10/40) of patients cases, being (4 of them were already treated on with G-CSF) Comparison with a group of 236 pAN patients of the INR showed that sAN were older at diagnosis (P<0.0001), had far inferior rate of resolution (P<0,0001), were more frequently leucopenic (p<0,0001), more rarely with monocitosis (p=0.015), had more frequently CD19 and NK depletion (p<0.00019), associated cytopenia and autoimmune symptoms and markers ( p<0.0001) while infection burden were slightly increased but not significantly different compared with pAN( p=0.2). Conclusions This registry study describes the clinical phenotype of sAN appearing in childhood and by comparative analysis shows that sAN substantially differs from pAN. sAN indeed appears an epiphenomenon of a complex immunological disturbances rather than a disease itself. Occasionally mutations of genes of immunodeficiency/disimmunity can be demonstrated Disclosures No relevant conflicts of interest to declare.

P5747The effect of additional intracoronary papaverine administration during hyperemia with intravenous adenosine triphosphate infusion, on fractional flow reserve values

Abstract Introduction Fractional flow reserve (FFR) measurement requires the achievement of steady-state maximum hyperemia. One of the main agents used for the induction of hyperemia is adenosine-triphosphate (ATP). But, in some cases, hyperemia may be insufficient, which leads to an underestimation of the true value of the FFR. Purpose To determine the effect of additional intracoronary papaverine administration during hyperemia with intravenous ATP infusion, on FFR values in a group of patients with borderline values. Methods A total of 165 measurements of FFR were performed in 119 patients. Intravenous infusion of ATP 140 μg/kg/min was used in all patients. In the group of patients with borderline FFR values (28 pts, 0.79–0.86), during achieved ongoing hyperemia, papaverine was additionally administered intracoronary (20 mg for LCA and 12 mg for RCA) with a reassessment of FFR values. The change in the FFR values and hemodynamic parameters were determined. Results The average values of FFR during hyperemia with ATP were 0.82±0,02. After additional administration of papaverine, a significant decrease in the mean values of FFR to 0.79±0,03 (p<0.001) occurred. Wherein a decrease in the FFR value by 0.03 or more was noted in 12 patients (43%), a decrease by 0.01–0.02 - in 12 patients (43%), unchanged in 4 patients (14%). In 15 patients (53%), a change in FFR led to a crossing of the threshold value of 0.80 and a change in treatment strategy. With intravenous infusion of ATP, was observed a decrease in systolic blood pressure (BP) by 10.6% (132 vs 118 mm Hg, p<0.001), a decrease in mean BP by 12% (101 vs 88 mm Hg, p<0.001) compared to the base pressure. With additional administration of papaverine, systolic BP decreased by more 12% (to 104 mm Hg, p<0.001), mean BP – by more 11% (to 78 mm Hg, p<0.001). Changes in blood pressure Rest ATP Papaverine Systolic BP, mm Hg 132±22 118±23 104±19 Mean BP, mm Hg 100±13 88±14 79±11 Changes in the values of FFR Conclusions Additional intracoronary papaverine administration during hyperemia with intravenous adenosine triphosphate infusion led to a decrease in FFR values of 0.02 or more in 68% of cases. It may indicate a insufficiency of the initial hyperemia induced by only one vasodilator and require a combination of pharmacological agents to achieve lower and more accurate values. At borderline values of FFR obtained by induction of hyperemia with a single hyperemic agent (ATP), the additional administration of a second hyperemic agent (papaverine) in 53% led to a crossing of the threshold value of 0.80 and a change in treatment strategy.

1619P - Impact of cognitive-behavioral-therapy (CBT) on levels of anxiety, depression and distress in cancer patients (pts)

BackgroundOncological pts usually experience symptoms that include anxiety, depression and distress. The aim of this preliminary study was to explore the effect of Cognitive-Behavioral-Therapy (CBT) in cancer pts. MethodsAn open trial evaluated the treatment effects of CBT in breast and lung pts referring to a clinical psychology health service specialized in psycho-oncology. Levels of anxiety and depression were assessed using the validated self-report questionnaires Hospital Anxiety and Depression Scale (HADS), while the distress was evaluated with the Distress Thermometer (DT). The statistical analysis includes the Wilcoxon-Mann-Whitney and the Spearman rank tests. ResultsAt a median follow-up of 6 months, data from 43 pts (88% breast and 12% lung cancer) were prospectively collected (median age: 49 years). At baseline, 62.8% and 44.2% of pts were borderline abnormal for anxiety and depression, while 34.9% and 30.2% reported abnormal levels. All pts presented high levels of distress. A significant correlation between anxiety and depression was observed (rs=0.55; p<0.01), as well as distress (rs=0.78; p<0.01) and baseline body mass index (BMI) (rs=0.41; p<0.01). Moreover, depression was associated with distress (rs=0.70; p<0.01), age (rs=0.30; p=0.05) and time from diagnosis (rs=0.30; p=0.04). Six months after the CTB, only 7% and 5% of pts had abnormal levels of anxiety and depression, while borderline abnormal values were observed in 58% and 40% of pts, respectively. Furthermore, after CTB the levels of anxiety (p<0.001), depression (p<0.001) and distress (p<0.001) were significantly lower than baseline. Of interest, a sub-analysis among breast cancer pts showed that baseline BMI was related to anxiety (rs=0.49; p=0.002) and distress (rs=0.37, p=0.02). Physical activity level was inversely associated with anxiety (rs=-0.41; p=0.01), depression (rs=-0.49; p=0.002) and distress (rs=-0.40; p=0.01). ConclusionsThese results highlight the importance of the introduction in clinical routine of validated psychological screening for anxiety, depression and distress as well as psychological intervention, carried out by trained psycho-oncology. Legal entity responsible for the studyUniversity of Verona. FundingHas not received any funding. DisclosureE. Bria: Honoraria (self): MSD, AstraZeneca, Celgene, Pfizer, Helsinn, Eli Lilly, BMS, Novartis, and Roche. ; Research grant / Funding (self): AIRC-IG 20583. M. Milella: Honoraria (self): Pfizer, EUSA Pharma, AstraZeneca. S. Pilotto: Honoraria (self): AstraZeneca, Eli Lilly, BMS, Boehringer Ingelheim, Roche, MSD and Istituto Gentili. ; Research grant / Funding (self): AIRC-IG 20583. All other authors have declared no conflicts of interest.

Early variation of 18-fluorine-labelled fluorodeoxyglucose PET-derived parameters after chemoradiotherapy as predictors of survival in locally advanced pancreatic carcinoma patients

To investigate if early variation of PET-derived parameters after concomitant chemoradiotherapy (CRT) predicts overall survival (OS), local relapse free survival (LRFS), distant relapse free survival (DRFS) and progression free survival (PFS) in locally advanced pancreatic cancer (LAPC) patients. Fifty-two LAPC patients (median age: 61 years; range: 35-85) with available FDG PET/CT before and after RT (2-6 months, median: 2) were enrolled from May 2005 to June 2015. The predictive value of the percentage variation of mean/maximum standard uptake value (ΔSUVmean/max), metabolic tumour volume (ΔMTV) and total lesion glycolysis (ΔTLG), estimated considering different uptake thresholds (40-50-60%), was investigated between pre- and post-RT PET. The percentage difference between gastrointestinal cancer-associated antigen (ΔGICA) levels measured at the time of PET was also considered. Log-rank test and Cox regression analysis were performed to assess the prognostic value of considered PET-derived parameters on survival outcomes. The median follow-up was 13 months (range: 4-130). At univariate analysis, ΔTLG50 showed borderline significance in predicting OS (P = 0.05) and was the most significant parameter correlated to LRFS and PFS (P = 0.001). Median LRFS was 4 and 33 months if ΔTLG50 was below or above 35% respectively (P = 0.0003); similarly, median PFS was 3 vs 6 months (P = 0.0009). No significant correlation was found between PET-derived parameters and DRFS, while the ΔGICA was the only borderline significant prognostic value for this endpoint (P = 0.05). PET-derived parameters predict survival in LAPC patients; in particular, ΔTLG50 is the strongest predictor. The combination of these biochemical and imaging biomarkers is promising in identifying patients at higher risk of earlier relapse.

Characterisation of lesions undergoing ischaemia-driven revascularisation after complete revascularisation versus culprit lesion only in patients with STEMI and multivessel disease: a DANAMI-3-PRIMULTI substudy

Treatment of the infarct-related artery only (IRA only) in ST-segment elevation myocardial infarction (STEMI) is associated with a significantly higher rate of ischaemia-driven revascularisation (ID-RV) during follow-up than fractional flow reserve-guided complete revascularisation (FFR-CRV). This study aimed to characterise all lesions which underwent ID-RV in the DANAMI-3-PRIMULTI trial with respect to location, stenosis grade and functional significance. The study included 627 patients with STEMI and multivessel disease; 313 patients were randomised to treatment of the IRA only versus 314 undergoing staged FFR-CRV during the index admission. Rates of admission for suspected cardiac ischaemia (17%) were similar in both groups; however, ID-RV was significantly less frequent in the FFR-CRV group than in the IRA-only group (5% vs. 17%; p<0.001). In both groups, the primary reason for ID-RV was related to non-culprit, non-treated lesions (N=71/82 lesions in IRA-only; N=13/26 in FFR-CRV). De novo lesions or revascularisation of previously treated lesions were rarely causes of ID-RV. In the IRA-only group, there was a trend towards a higher ID-RV rate for lesions with a higher stenosis grade and located in more proximal segments - in particular, ≥80% stenosis of the left anterior descending and right coronary artery also led to angina class IV/unstable angina. In the FFR-CRV group, an FFR value ≤0.80 was shown to be an appropriate threshold for revascularisation. FFR-CRV in STEMI is associated with a significantly lower rate of ID-RV at follow-up than treatment of the IRA only. This is due to a difference in non-culprit, non-treated lesions between both groups and not in de novo lesions or repeat revascularisation of previously treated lesions. Further considerations are warranted in case of high-grade non-culprit stenosis at proximal coronary segments, borderline FFR values and/or anticipated complex PCI.

Cell Density Counts of the Intestinal Intraepithelial Lymphocytes in the Celiac Patients.

Increased number of intestinal intraepithelial lymphocytes (IELs) is a key histological finding in the diagnosis of celiac disease (CD); however, the number of IELs in celiac patients and healthy subjects may vary from one region to another. Additionally, there are some seronegative celiac patients with a borderline histology. To determine the number of the CD3+ and CD8+ IELs T-cells in the celiac patients and healthy subjects (controls) in Isfahan. The duodenal biopsies were obtained from the celiac patients (n=15) and the controls (n=19). The total number of IELs/100 epithelial cells (ECs) were counted using the hematoxylin-eosin (H&E) staining method, and that of CD3+ and CD8+ IELs/100 ECs were counted using the immunohistochemistry (IHC) staining method. This study defined the upper normal limit for each variable as mean + 2SD. Accordingly, the upper normal limits of the total IELs, CD3+ IELs, and CD8+ IELs/100 ECs were calculated as 37 (95% confidence intervals, CI: 33-41), 22 (95% CI: 19-25) and 12 (95% CI: 10-14), respectively. In 3 clinically CD diagnoses, the total IELs counts/100 ECs were below the upper normal limit, and the histopathological and serologic assays were negative. Nevertheless, the CD8+ IELs T-cells counts/100 ECs showed borderline values. Interestingly, these patients responded to a gluten-free diet (GFD). The study findings suggest that in the clinically diagnosed celiac disease, IELs count/100 ECs below the upper normal limit as well as negative histopathological and serologic assays and the cell density counts of the CD8+ IELs T-cells/100 ECs could be a useful parameter in CD diagnosis and make a decision to put them on a GFD.

Preliminary Study to Evaluate Marginal Bone Loss in Cases of 2- and 3-Implant-Supported Fixed Partial Prostheses of the Posterior Mandible.

The purpose of this study was to evaluate, by radiographic examinations, the marginal bone resorption around implants in cases of 2 and 3 implant-supported fixed partial prostheses (FPPs) at the posterior mandible. A retrospective study of 41 patients (23 males, 18 females) of an average age of 67 years (range, 53-85), with 2 and 3 implants-supported FPPs in the posterior mandible that were treated during 2006 to 2015. The mean follow-up time was 6.32 years (range, 2-10). Twenty-four patients had FPPs on 2 implants (a total of 48 implants). Seventeen patients had FPPs on 3 implants (a total of 51 implants). Clinical and radiographic follow-up examinations were performed. All radiographs were analyzed for changes in marginal bone height surrounding the implants. The mean marginal bone loss around the most mesial implant was slightly higher in the 2-implant group (0.833 mm) compared with the 3-implant group (0.431 mm). The correlation between the mean marginal bone loss around the most mesial implant and the number of implants was of borderline value (P = 0.055). Considering the limitations of this preliminary study, the authors found that the mesial implant in the 2-implant group is more susceptible to marginal bone loss.

SAT-252 Risk Behaviors and Metabolic Syndrome in Adolescents

Objective: to evaluate risk behaviors for obesity and components of metabolic syndrome in adolescents. Methods: An observational, descriptive, cross-sectional study, in which 120 individuals were evaluated, ages between 14-19 years, students from both morning and night periods of a public school in Curitiba. Results: 34.7% of the students presented body mass index higher than expected for their age. Normal or borderline values were observed for blood pressure in 91.1% of the students and for abdominal circumference in 95.2%. Only 29.1% of them reported physical activities for more than 300minutes/week; 2 hours/day or more watching TV or playing videogames, activities considered sedentary, were reported by 17,3% and 23,6%, respectively. Presence of metabolic syndrome was higher in students from the night period (OR= 4,72). 34 students (30,9%) reported they smoked or had smoked and only 26 (23,4%) reported they had never drunk alcoholic beverages. Conclusion: frequency of excess weight was higher in our study than previous reports in national studies. The prevalence of hypertension and abdominal obesity was considered low. Components of metabolic syndrome were more frequent in students from the evening period. Key Words: adolescents, obesity, blood pressure, cardiovascular risk, risk behavior.

Harmonization of cut-off values of commercially available D-dimer tests

The objective of the D-dimer tests is to exclude venous thromboembolic disorders. The characteristics of various D-dimer tests differ significantly and consequently, their results are difficult to compare. Our goal was to compare three D-dimer tests, analyse their correlation and harmonise their sensitivity and specificity through the optimisation of cut-off values. At Semmelweis University, the D-dimer level was determined with three different reagents in 158 plasma samples, suspected with venous thromboembolism. INNOVANCE D-Dimer was selected as the referent, and in the case of the two other tests (STA-Liatest D-Di; Dia-D-Dimer), the cut-off values were changed between 0.2-1 µg/ml (fibrinogen-equivalent unit - FEU). The optimal cut-off values were estimated by diagnostic parameters and chi-square test. The correlation of the different tests was calculated by regression analysis. Based on the chi-square statistics, there is no significant difference between STA-Liatest D-Di and INNOVANCE D-Dimer tests using the cut-off values 0.3-1 µg/ml (FEU) (STA-Liatest D-Di). In the case of Dia-D-DIMER, there is a significant difference using 0.2-0.3 µg/ml (FEU) cut-off values, 0.4 µg/ml (FEU) is a border-line value and using 0.5-1 µg/ml (FEU) cut-off values, there is no significant difference. The sensitivity of STA-Liatest D-Di changed between 82.7-100% using 0.2-1 µg/ml (FEU) cut-off values, while the sensitivity of Dia-D-DIMER was 92.3-100%. Their specificities ranged between 50-96.3% and 35.2-87%. The optimal cut-off values were estimated as 0.5-0.6 µg/ml (FEU) for the STA-Liatest D-Di test and 0.7 µg/ml (FEU) for the Dia-D-DIMER test. Each diagnostic laboratory should determine the optimal cut-off value of the D-dimer test in use, considering the examined population of the area. Orv Hetil. 2019; 160(15): 585-592.

ASSESSMENT OF VITAMIN PROVISION OF THE POPULATION OF THE LARGE ADMINISTRATIVE AND ECONOMIC CENTER OF THE WESTERN SIBERIA

Evaluation of vitamin status in residents of the Omsk city (106 men and 135 women) aged of from 18 to 75 years according to the serum content of vitamins A, D, E, K, C, B1, B5, B6, B9, B12. Lack of vitamins in the majority of the observed cases (63.2 ± 3.8%) had a combined character. There was revealed pronounce lack of vitamin D and folic acid, respectively in 70.9 ± 3.6% and 63.2 ± 5.6% of observed persons. The substantial proportion of the population was found to suffer from lacks of vitamin B1 (47.5 ± 4.2%), B6 (49.7 ± 3.8%), and vitamin E (47.1 ± 4.0%). The frequency of detection of a reduced availability of vitamin C was 16.2 ± 3.4%, B12 - 13.2 ± 3.2%, respectively. The deficiency of vitamin A deficiency was seldom (from 5.8 ± 1.9%). In the sample no person with a deficiency of vitamin K and pantothenic acid (B5) was revealed. Mediane of concentrations of phylloquinone, retinol and ascorbic acid and cyanocobalamin in blood serum were in the range of optimum values. Borderline values of the content (at the level of the lower limit of normal) were seen for vitamin E, B1, B6. There were found age differences in the availability of vitamins E, K, ascorbic acid.

Evaluation of the NovaLisa™ Leishmania Infantum IgG ELISA in A Reference Diagnostic Laboratory in A Non-Endemic Country

Anti-Leishmania antibodies may be detectable in patients with leishmaniasis. Here, we compared a commercial enzyme-linked immunosorbent assay (ELISA) for the detection of anti-Leishmania antibodies, with an immunofluorescence antibody test (IFAT) that is no longer commercially available. Eighty-six serum samples from 73 patients were tested. The results obtained by the NovaLisa™ Leishmania infantum IgG ELISA, interpreted according to the instructions of the manufacturer, but with a modified cut-off for borderline positive values, were compared with the IFAT results that were already available. Moreover, Leishmania Western blot IgG results were available for 43 of the samples. The overall concordance of ELISA and IFAT was 67%. The ELISA and IFAT tests scored as 24% and 15% of the samples being positive, respectively, while 13% and 33% scored as borderline-positive, respectively. Using a Western blot (WB) as the reference, the sensitivities and specificities for the positive plus borderline-positive samples combined was 95.5% (95% confidence interval (CI), 77.2–99.9%) and 81.0% (95% CI, 58.1–94.6%) for ELISA, and 95.5% (95% CI, 77.2–99.9%) and 42.9% (95% CI, 21.8–66.0%) for IFAT, respectively. Overall, the ELISA proved to be a cost-effective alternative to the IFAT, due to its higher accuracy and specificity, and with a consequently lower number of confirmatory WB tests being required. Lastly, we also present data on the associations between seroconversion and the type of leishmaniasis.

The Reg`Activ Cholesterol Positive Effects in Asymptomatic Volunteers with Borderline Values of Cardio-Metabolic Risk Factors are Sustainable in Long-Term Run

The Reg`Activ Cholesterol Positive Effects in Asymptomatic Volunteers with Borderline Values of Cardio-Metabolic Risk Factors are Sustainable in Long-Term Run

Apolipoprotein E4 genotype in combination with poor metabolic profile is associated with reduced cognitive performance in healthy postmenopausal women: implications for late onset Alzheimer's disease.

We hypothesized the association of metabolic profile on cognition in postmenopausal women will be greater among ApoE4 carriers compared with noncarriers. Metabolic biomarkers and measures of global cognition, executive functions, and verbal memory, collected among postmenopausal females, were used in this analysis. Clustering analyses of metabolic biomarkers revealed three phenotypes: healthy, predominantly hypertensive, and poor metabolic with (borderline normal laboratory values). General linear models tested whether an association of metabolic cluster with cognition differed by ApoE4 genotype. In the total sample of 497 women, verbal memory was lower in the poor metabolic cluster (P = 0.04). Among ApoE4+ women, performance in all cognitive domains was lowest in the poor metabolic cluster. Differences in executive functions among metabolic clusters were detected only in ApoE4+ women (P value for interaction = 0.003). In a general population of postmenopausal women, association between poor metabolic profile with reduction in cognitive performance is more apparent in women who carry an ApoE4 allele. These data indicate a window of opportunity for interventions to reverse the trajectory of the preclinical phase of Alzheimer's disease.

Content of toxic elements in tissues of hunted animals on the basis of research results of 2003–2017

The aim of the study was to synthesize the latest literature data on the content of toxic elements in tissues of hunted animals and to determine whether there is a health risk associated with consumption of these products in the light of current legal regulations. The data show the increased mean lead contents in kidneys of wild boar (1.1900 mg/kg) and roe deer (0.9060 mg/kg) and in the muscle tissue of wild boar, roe deer and deer; the contents are even up to 0.1240 mg/kg, 0.1760 mg/kg and 0.2200 mg/kg, respectively. In addition, the increased mean cadmium content indicates the possibility of the deposition of this element in muscle tissue of wild boars (0.0519 mg/kg) and deer (0.1000 mg/kg), as well as in the liver of wild boars (5.5730 mg/kg) and roe deer (6.4350 mg/kg) and in kidneys of game species, sometimes far above the applicable maximum levels. The highest mean cadmium contents in kidneys of wild boar, roe deer and deer are 49.5000 mg/kg, 80.2600 mg/kg and 4.9740 mg/kg, respectively. The mean values of the amount of arsenic do not usually exceed the legally established maximum levels of this element. Only the borderline value of arsenic in muscle tissue of roe deer is slightly exceeded and amounts to 0.2700 mg/kg. There is the possibility of the accumulation of larger amounts of mercury mainly in kidneys of deer and roe deer. The highest mean content of this element of 0.1001 mg/kg is demonstrated in the kidneys of deer. The research on the content of toxic elements in meat of hunted animals indicates the need to regularly monitor the quality of the obtained raw material as well as to exclude selected tissues of wild animals from consumption.

Mental health of children from a war affected border village: a cross sectional comparative study

Background Sri Lankan government had a war against terrorism for thirty years in North and East of Sri Lanka. There were villages in the North-East border that the LTTE held territory and the community living in those villages faced frequent attacks during those three decades. The present study was conducted to compare the mental health of children in a war affected border village, with the mental health of same aged children from a village not directly affected by the war. Methods Grade 8 and 9 students (n=148) from a government school were selected as subjects and a self-administered questionnaire and the validated Sinhalese version of the Strengths and Difficulties Questionnaire (SDQ) were completed. Age matched 138 students were selected as the comparison group, from an area which is socioeconomically similar but not affected by the war as a border village. Same questionnaires were completed by the comparison group. Results Subject group consisted of 76 (51%) males and 72 (49%) females. Age ranged from 12-16 years (median 14, IQR 13-14). Majority (n=85, 57.0%) of children living in the border village experienced some kind of an extremely terrifying incident related to the war. Nearly one fifth (n=26, 17.6%) living in the border village, had lost at least one immediate family member due to terrorist attacks. Majority of the border village children (n=94, 63.5%) believed that the war produced a significant negative impact on their lives. Children living in the border village showed 2.5 fold excess risk for a mental health problem (OR 2.5, 95% CI 1.4 to 4.5. Living in a border village carried 3 times excess risk for conduct problems (OR 3.1, 95% CI 1.6 to 6.0). Children living in the border village showed 2 fold excess risk for peer relationship problems (OR 1.9, 95% CI 1.1 to 3.2). Living in a border village carried 2 fold excess risk for hyperactivity/inattention problems (OR 2.3, 95% CI 1.2 to 4.2). Conclusions Majority of the children living in border village reported different exposures related to the civil war that can cause considerable and long-lasting psychological impact. Children from the border village had a significantly higher risk of showing borderline abnormal values on the SDQ, compared to children not from a border village. It is probable that this is due to the effect of war and its impact on the mental health of the children of the border village.

Diffuse myocardial fibrosis in adolescents operated with arterial switch for transposition of the great arteries - A CMR study

Diffuse myocardial fibrosis in adolescents operated with arterial switch for transposition of the great arteries - A CMR study