Larger Study Group Research Articles

Is Premenstrual Syndrome Associated with Inflammation, Oxidative Stress and Antioxidant Status? A Systematic Review of Case-Control and Cross-Sectional Studies.

Premenstrual syndrome (PMS) is a cyclically occurring combination of various symptoms, leading to decreased life quality among approximately 30% of women of childbearing age. PMS etiology remains unknown; however, there are some suggestions that inappropriate inflammatory response and oxidative stress are involved. This study aimed to systematically review case–control and cross-sectional studies investigating inflammation markers, oxidative stress, and antioxidant status among women with PMS and controls. The study protocol was registered with PROSPERO (no. CRD42020178545), and the authors followed the guidelines for performing a systemic review recommended by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). By searching PubMed and Scopus databases (up to 8 January 2021), six case–control studies and five cross-sectional studies of medium or high quality were classified to the review. The systematic review included 652 women with PMS and 678 controls, for whom 36 eligible markers were determined. Limited evidence indicates increased levels of inflammatory parameters and suggests decreased antioxidant status in PMS women. Insufficient data with inconsistent results made it impossible to formulate a firm conclusion on the contribution of oxidative stress in PMS occurrence. To acknowledge the role of inflammation, oxidative stress, and antioxidant status in the pathophysiology of PMS, further research with case–control design and large study groups is needed.

Potential Role of KRAS and BRAF in Epithelial Ovarian Cancer

KRAS and BRAF are key proto-oncogenes of MAPK/ERK pathway and are essential for cell growth and proliferation. Mutations of these oncogenes are known to have role in pathogenesis of epithelial ovarian carcinoma (EOC). However, limited studies have evaluated the role of KRAS and BRAF protein expression. Hence, this study aimed to explore their role in EOC patients, specifically to correlate KRAS and BRAF protein expression with the histological subtypes and other histopathological prognostic factors. Immunohistochemistry was performed using paraffin-embedded tumor tissue blocks of 55 untreated and histologically confirmed EOC patients and 20 benign ovarian tumors to study KRAS and BRAF protein expression. Data were analyzed using SPSS software. Cytoplasmic expression of both KRAS and BRAF was observed in EOC and benign tumors. KRAS protein expression was significantly higher in serous EOC patients than the mucinous EOC patients (P = 0.016). KRAS expression was also significantly positively correlated with the presence of lymphatic permeation (P = 0.030), while a trend toward significance was found with vascular permeation (P = 0.052). Furthermore, BRAF protein expression was significantly higher in EOC patients than in benign ovarian tumors (P = 0.027). Its expression was significantly higher in patients with moderately/poorly differentiated tumors than well-differentiated tumors (P = 0.008), and in patients having serous EOC than in mucinous EOC (P = 0.001). A trend of higher BRAF expression was also observed in patients with lymphnode metastasis (P = 0.079). KRAS and BRAF proteins have a potential role in EOCs. However, further studies in larger group of patients and follow-up for a longer period are required to identify their role in prognosis.

Changes in Back Pain Scores after Bariatric Surgery in Obese Patients: A Systematic Review and Meta-Analysis.

Bariatric surgery produces significant and quantifiable reductions in back pain. However, there is a lack of information on the association of weight changes after bariatric surgery with changes in pain score. We aim to evaluate the impact of bariatric surgery on back pain in obese patients and to address the association between changes in body mass index (BMI) and pain score. In obese patients eligible for bariatric surgery, the changes in pre- and post-operative pain scores, assessed by the Numeric Rating Pain Scale (NPS) or Visual Analogue Scale (VAS), were considered as primary outcomes. Mean difference (MD) and their 95% confidence intervals (CI) were evaluated. Eight cohort studies were included in the analysis of 298 obese patients undergoing bariatric surgery. All studies showed a reduction in back pain, with a mean change of −2.9 points in NPS and of −3.8 cm in VAS. There was a significant reduction in back pain (NPS: (MD = −3.49) (95% CI = −3.86, −3.12); VAS: MD = −3.75, (95% CI = −4.13, −3.37)) and BMI (MD = −12.93, (95% CI = −13.61, −12.24)) following bariatric surgery. No significant relationship between BMI change and decrease in clinical scores could be established. However, it was evident that bariatric surgery had a significant effect on back pain scores in severely obese patients. Ideally, a prospective study including spinal imaging, inflammatory markers, a longer follow-up period, and larger study groups with a randomized control group needs to be performed.

Solving the enigma of posterolateral tibial plateau fractures, the clue protocol

The study aim is to evaluate functional and radio- logical outcomes following a suggested protocol based on the four-column classification for management of posterolateral column tibial plateau fractures. A prospective cohort study was performed in level I academic center on 42 patients with mean age of 36 years (22-59). Eleven patients had isolated posterolateral column fractures whereas 31 patients had associated columns fractures. According to the suggested protocol, all cases of isolated posterolateral column fracture started treatment via arthroscopic evaluation of soft tissue injuries (menisci and liga- ments), arthroscopically assisted reduction and inter- nal fixation by rafting screws followed by ORIF if plating was needed. If associated with other columns fractures, columns were fixed sequentially in an anti-clockwise direction starting from anteromedial column. Average follow up was 26 months. Mean time to union was 16.3 (12-22) weeks. No radiological evidence of loss of coronal or sagittal alignment was detected at final follow up. Five patients had an average depression of 5 millimeters that did not need further intervention at this short-term follow up. Mean KOOS was 81 (72- 88). The average knee range of motion was (0° - 127°). One patient had temporary common peroneal nerve injury, one patient had deep infection and two had superficial wound infection. implementing the suggested protocol gives good to excellent radiological and functional results as regard posterolateral tibial plateau fracture. A larger study group with longer follow up is needed.

The role of VEGF rs699947 polymorphism in End-Stage Renal Disease: A preliminary study

Aim: End-Stage Renal Disease (ESRD) is an important public health problem worldwide with an increasing incidence and prevalence. There are many environmental and genetic factors which contribute to the development of ESRD. Vascular endothelial growth factor (VEGF) has been suggested to play an important role in renal pathophysiology. The aim of this study was to determine the probable relation between ESRD and VEGF gene rs699947 polymorphism in Turkish population. Material and Method: Genotyping of rs699947 was carried out in 50 ESRD patients on dialysis treatment and 30 healthy controls, using a Kompetitive Allelic-Specific PCR (KASP) method following DNA isolation. Demographic and clinical characteristics of the patients were recorded. Results: The prevalance of rs699947 AA genotype was found to be higher in the control group, but it was not statistically significant (p>0.05) . Conclusion: Although statistically insignificant, the frequency of AA genotype was higher in the control group compared to the case group, therefore we concluded that AA genotype may be a protective factor for ESRD in Turkish population. However, this conclusion needs to be further verified by future studies performed in larger study groups.

Disclosing Pharmacogenetic Feedback of Caffeine via eHealth Channels, Assessment of the Methods and Effects to Behavior Change: A Pilot Study.

Background: The integration of genetic testing into eHealth applications holds great promise for the personalization of disease prevention guidelines. However, relatively little is known about the impact of eHealth applications on an individual's behavior.Aim: The aim of the pilot study was to investigate the effect of the personalized eHealth application approach to behavior change in a 1-month follow-up period on groups with previously known and unknown caffeine impacts.Method: We created a direct-to-consumer approach that includes providing relevant information and personalized reminders and goals on the digital device regarding the caffeine intake for two groups of individuals: the intervention group (IG) with the genetic raw data available and the control group (CG) to test the impact of the same content (article about caffeine metabolism) on participants without the genetic test. Study participants were all Estonians (n = 160).Results: The study suggests that eHealth applications work for short-term behavior change. Participants in the genetic IG tended to increase caffeine intake if they were informed about caffeine not being harmful. They reported feeling better physically and/or mentally after their behavioral change decision during the period of the study.Conclusions: Our pilot study revealed that eHealth applications may have a positive effect for short-term behavior change, regardless of a prior genetic test. Further studies among larger study groups are required to achieve a better understanding about behavior change of individuals in the field of personalized medicine and eHealth interventions.

969 Correlation between low pre-pregnancy body mass index and adverse perinatal outcomes

The aim of this study is to determine if a low pre-pregnancy BMI, specifically <18.5 (underweight) leads to adverse intrapartum and neonatal outcomes, primarily rate of cesarean delivery. After Baylor College of Medicine IRB was obtained, charts of women with who delivered between January 1, 2011 to January 1, 2018 at Ben Taub General Hospital and Texas Children’s Hospital – Pavilion for Women were reviewed. Demographic, intrapartum and postpartum variables were recorded including age, race, parity, mode of delivery, and neonatal outcomes. 71, 134 charts were available for review. Means and standard deviations were used to analyze demographic variables and chi square analysis was used to compare study groups. Of the greater than 70, 000 charts available for review, 1, 115 women had a pre-pregnancy BMI of less than 18.5. Of these women, 198 (17.7%) underwent cesarean delivery. Contrarily, 60, 097 women had a pre-pregnancy BMI of greater than 18.5 (normal weight, overweight, obese) with a cesarean delivery rate of 15% (p=0.040). Additionally, neonatal outcomes such as fetal growth restriction (FGR) were significantly impacted by low pre-pregnancy BMI, with greater than double the rates in underweight women. While much focus is placed on adverse maternal outcomes in higher BMI strata, there is also significant potential for poor outcomes in underweight women. There has previously been a paucity of data investigating women in this cohort, however our large study group and findings demonstrate the need to focus on appropriate weight and weight gain for these women during the antenatal period to decrease cesarean delivery rates and improve perinatal prognosis for both mother and infant.

Mapping Tree Species Using Advanced Remote Sensing Technologies: A State-of-the-Art Review and Perspective

Timely and accurate information on tree species (TS) is crucial for developing strategies for sustainable management and conservation of artificial and natural forests. Over the last four decades, advances in remote sensing technologies have made TS classification possible. Since many studies on the topic have been conducted and their comprehensive results and novel findings have been published in the literature, it is necessary to conduct an updated review on the status, trends, potentials, and challenges and to recommend future directions. The review will provide an overview on various optical and light detection and ranging (LiDAR) sensors; present and assess current various techniques/methods for, and a general trend of method development in, TS classification; and identify limitations and recommend future directions. In this review, several concluding remarks were made. They include the following: (1) A large group of studies on the topic were using high-resolution satellite, airborne multi-/hyperspectral imagery, and airborne LiDAR data. (2) A trend of “multiple” method development for the topic was observed. (3) Machine learning methods including deep learning models were demonstrated to be significant in improving TS classification accuracy. (4) Recently, unmanned aerial vehicle- (UAV-) based sensors have caught the interest of researchers and practitioners for the topic-related research and applications. In addition, three future directions were recommended, including refining the three categories of “multiple” methods, developing novel data fusion algorithms or processing chains, and exploring new spectral unmixing algorithms to automatically extract and map TS spectral information from satellite hyperspectral data.

Evaluation of Serum Concentration of the Myokine Irisin (FNDC5) in Patients with Age-Related.

Objectives:This study evaluated the serum irisin level of patients with age-related macular degeneration (ARMD) and compared it with that of healthy individuals.Methods:The serum irisin level of 15 healthy controls (Group 1) and 15 dry ARMD patients (Group 2) and 15 wet ARMD patients (Group 3) were measured using the enzyme-linked immunosorbent assay (ELISA) method and compared.Results:There was no statistically significant difference between the groups in terms of age or gender (p>0.05). The mean serum irisin levels of Group 1, Group 2, and Group 3 were 25.81±24.04 ng/mL, 22.93±19.05 ng/mL, and 12.38±8.16 ng/mL, respectively. Although the mean irisin level in the wet ARMD patients was lower than that of the control and dry ARMD groups, there was no statistically significant difference between the groups (p>0.05).Conclusion:The results suggest that the serum irisin level in ARMD patients is not different from that of healthy individuals. Studies of larger groups that examine the irisin level in the vitreous and neovascular membranes will further elucidate any role in the pathogenesis of ARMD.

The Study of Electroencephalographic Changes in Patients Diagnosed with Dementia

Dementia refers to a group of disorders caused by the gradual dysfunction and death of brain cells. This disorder can be described clinically as a syndrome that causes a decline in cognitive domain (i.e., attention, memory, executive function, visual-spatial ability, and language)EEG may play an important role in detecting and classifying dementia because of its significant influence on dementia abnormalities in terms of rhythm activity .An increase in EEG slow wave activity (theta and delta frequencies) together with decreased activity in the alpha frequency band are considered to be typical findings in the various types of dementia. Aim and Objective: An analysis of electroencephalographic changes in patients diagnosed with dementia and trying to find significance in diagnosis. Methods and Materials: This study is an observational cross sectional study carried out in 30 patients diagnosed with dementia attending outpatient department in a tertiary care Hospital over a period of 6 months. Subjects are enquired about their history of diagnosis, family history, Treatment history and diagnostic tests such as EEG. Additionally MMSE scoring was also performed for all patients. Results: Out of the 30 patients dementia incidence was higher in males (56.66 %) compared to females (43.33 %). EEG was found to be normal in 9 patients and abnormal in 21 patients. The study also shows a statistically significant correlation between MMSE Scoring and EEG Findings in patients with dementia. Conclusion: There is a definite EEG abnormality found in majority of the patients. Combined MMSE scoring and EEG in evaluation of dementia patients in larger study group will reveal more insight.

Borderline Dysplasia with Acetabular Retroversion: Key Findings in Large Hip Arthroscopy Study Group

Borderline Dysplasia with Acetabular Retroversion: Key Findings in Large Hip Arthroscopy Study Group

Splenomegaly and hypersplenism in hepatic vena cava syndrome.

Background and Aim:Hepatic vena cava syndrome (HVCS) is a bacterial infection-induced obliterative disease of the inferior vena cava at the site of the hepatic vein openings that causes chronic liver disease with a high incidence of liver cirrhosis and a moderate incidence of hepatocellular carcinoma (HCC). HVCS typically manifests clinically as recurrent mild jaundice and/or a mild elevation of transaminases or ascites as a result of hepatic venous outflow obstruction. This study is an investigation of the complications and treatment results of a large cohort of HVCS patients with an emphasis on splenomegaly and hypersplenism.Materials and Methods:A total of 1935 (1335 male and 600 female) patients with HVCS seen between 2004 and 2019 for splenomegaly and hypersplenism were enrolled in this retrospective study. The incidence of splenomegaly, ascites, cirrhosis, HCC, and other complications was measured and analyzed.Results:Long-term follow-up of a large study group seen over several years indicated that 16% had mild splenomegaly, and 50% of these developed cytopenia commonly thrombocytopenia and/or leucopenia.Conclusion:The development of hypersplenism was related to recurrent or prolonged acute exacerbation of HVCS. This resulted in an increased incidence of ascites and cirrhosis as well as complications, such as hepatic encephalopathy, gastrointestinal or mucosal bleeding, or mortality.

Sonoelastographic Assessment of the Achilles Tendon in Familial Mediterranean Fever Patients: Comparison With Healthy Subjects.

Introduction and objective: This study aims at using sonoelastography as a novel technique to evaluate the stiffness and thickness of Achilles tendons in familial Mediterranean fever (FMF) patients.Methods: Achilles tendons of 26 FMF patients and 23 control subjects were assessed with ultrasound and real-time sonoelastography. The Achilles tendons were divided into the distal, middle, and proximal thirds for elastographic image evaluation. Tendons were classified into three main types according to their elasticity features: grade 1 blue (hardest tissue) to green (hard tissue); grade 2, yellow (soft tissue); and grade 3, red (softest tissue). Tendons of the groups were compared in terms of thickness and stiffness.Results: There were no significant differences in thickness and stiffness of the Achilles tendon between FMF patients and controls (p>0.05). Sonoelastography of Achilles tendons of FMF patients displayed no relationship between FMF and tendinopathy. Conclusion: This issue should be explored in prospective studies in larger groups.

Failures and Successes in Pediatric Patients with Acute Myeloid Leukemia with First Relapse: A Large International Report on Current Treatment Strategies and Outcome

BACKGROUND: Children with high risk acute myeloid leukemia (AML) still experience consistently high rates of relapse. Survival after first relapse increased from 21% between 1987 and 1997 up to 39% in recent studies. However, since 2009, there have been no publications on subsequent large pediatric AML relapse trials. As the indications for HSCT during first-line treatment have been extended since then, the current survival of these patients at relapse remains unclear. Herein, we report outcome results from the BFM and COG study group, which represents the largest available dataset analyzed for post-relapse survival. PATIENTS AND METHODS: Pediatric patients with first relapse of AML (no Down syndrome, secondary leukemia or FAB M3) have been analyzed from two large study groups with patients from the United States, Canada, Australia, New Zealand, Germany, Austria, Czech Republic and Switzerland. Out of 1222 patients in the BFM cohort (AML-BFM study 2004, registry 2012 and study 2012), 350 experienced at least one relapse and 197 of those had a first relapse after closure of the last I-BFM relapse trial (04/2009 through 2017). Within the Children's Oncology Group (COG) Phase 3 trials (AAML0531 and AAML1031, n=2119) 852 pediatric patients suffered a relapse. Five-year probability of overall survival (pOS) and event-free survival (pEFS) were calculated according to Kaplan-Meier. EFS was calculated for the BFM cohort as time from relapse to the next event (second relapse, death, failure to achieve a second remission or secondary malignancy) or until last follow-up, while OS reflects the time from relapse until death or last follow-up. The Cox proportional hazards model was used for multivariate analysis of outcomes. Living patients were censored at last follow-up with a median follow-up after relapse of 4·2 years (BFM) and 4·8 years (COG). Data have been frozen at 03/27/2020 (BFM) and 03/31/2020 (COG). RESULTS: In the 197 patients with relapse after closure of the last BFM relapse trial (04/2009 through 2017) the pOS at 5 years was 42±4% (BFM). The 5-year pOS in patients relapsing after COG trials 2006-2018 was 35±2% (n=852). Patients experiencing a relapse between 2014 to 2017 had a pOS of 49±6% (BFM, n=78) and 40±3% (COG, n=333). Risk classification at initial diagnosis and a short time from diagnosis to relapse predicted a diminished survival probability in both cohorts (see Table 1). However, the absence of full hematopoietic regeneration of the bone marrow after re-induction did not predict survival: Within the BFM dataset, a subgroup analysis in all patients receiving DNX-FLA (n=156) have been performed. Initial characteristics are comparable to the total cohort. Among these patients 147 were evaluable for response (7 excluded due to early death before evaluation, 2 for insufficient data). Eighty-nine (57%) achieved a CR (n=69) or CRp (n=20) and 52 (33%) no response. Overall survival was superior for patients with a CR/CRp (54±6% (CR/CRp) vs. 32±7% (No CR/CRp); p=0·0064), but long-term survival was still possible even with a poor re-induction response. Patients with a CRp had a comparable survival to those with a CR after a second re-induction (pOS 60±11% (CRp) vs. pOS 52±7% (CR); p=0·57). Patients with &amp;gt;5% leukemic blasts (n=32) had the lowest survival (pOS 27±9%). The 5-year pEFS for this cohort was 29±4% (pEFS 50±6% (CR) vs. pEFS 50±11% (CRp)). The analysis of post-relapse treatment showed that the vast majority of patients who survive had a HSCT following relapse. By landmark analysis, survival was significantly higher in patients with subsequent HSCT compared to that of non-transplanted patients (BFM: pOS 53±4%, n=154 vs. pOS 5±5%, n=21; p(Mantel-Byar)=0·0002). CONCLUSION: This is the largest report to date on post relapse survival in children with AML. Our analysis confirmed previously described risk factors for poor survival while also highlighting new findings contrary to established standards. Strikingly, the absence of full hematopoietic regeneration of the bone marrow after re-induction did not predict survival at first relapse, thereby questioning the current value of the established International Working Group Criteria published by Cheson et al for response-evaluation in pediatric AML. As the international pediatric AML community embarks on collaborative efforts to evaluate new therapies in children with relapsed AML, a comprehensive review of post relapse survival is critical. Disclosures Bourquin: Servier: Other: Travel Support. Reinhardt:Novartis: Membership on an entity's Board of Directors or advisory committees; CLS Behring: Research Funding; bluebird bio: Membership on an entity's Board of Directors or advisory committees; Janssen: Membership on an entity's Board of Directors or advisory committees; Roche: Research Funding; Celgene Corporation: Membership on an entity's Board of Directors or advisory committees, Research Funding.

Okul Yöneticileri ve Öğretmenlere Göre Okulun Anlamlandırılması

School administrators and teachers' point of views towards the school is important for the school to achieve its goals. This research aimed to understand how school administrators and teachers accepted the school. The research was carried out using a causal-comparative research model. The sample group consisted of 318 school administrators and teachers selected using stratified random sampling. In this research, an organizational diagnostic scale consisting of 8 dimensions and 40 items was used. Independent t-test and one-way analysis of variance (ANOVA) were used to analyze the data. The reliability coefficient of the scale was 93. As a result of the research, a significant difference was determined in terms of human relations in favor of women considering the gender variable and attitude in favor of teachers considering the task variable. There was no significant difference considering the other variables and dimensions. The research data showed that the participants adopted positive values for the school, but experiences were not at the same level and effect in each school. It was understood that positive and negative thoughts on school experiences varied from school to school. For researchers, the following can be recommended: the current research can be repeated and the results can be compared with a larger study group. The subject can be investigated by different methods. Research results can be taken into account when establishing and developing educational policies. The results can be shared in different educational environments.

Metaphyseal sleeves in arthroplasty of the knee : Asuitable tool in management of major metaphyseal bone loss.

BackgroundThis study examined the clinical outcome following revision arthroplasty of the knee joint and severe arthrosis with metaphyseal bone defects and instability using metaphyseal sleeves. We analyzed the results based on established scores and recorded the complications occurring on revision arthroplasty.Material and methodsPatients with revision arthroplasty of the knee and metaphyseal bone defects grade III according to the Anderson Orthopedic Research Institute (AORI) classification were included (16 patients, 9 females and 7 males). In all cases, surgery was performed using an endoprosthesis COMPLETE™ revision knee system with metaphyseal sleeves.ResultsAll patients had a significant reduction in pain level after revision surgery. The median HSS score in the cohort with primary arthroplasty was 84 and in the cohort with revision arthroplasty 73 and the KSS was 83 and 55, respectively. According to the HSS an excellent result was achieved by 50% of the patients in the primary arthroplasty group and 25% in the revision group. Only three patients were considered to have an insufficient result. Postoperative pain was significantly reduced in both groups. The median ROM was 112° flexion in the primary arthroplasty group and 95° in the revision group. An extension deficit was observed in three patients and four patients showed prolonged wound healing postoperatively (25%), which was treated conservatively and did not lead to septic changes.ConclusionThe use of metaphyseal sleeves in patients with bone defects is a suitable instrument with no negative impact on the outcome both in primary and revision arthroplasty. Further studies with larger study groups and analysis of long-term results after use of such endoprosthetic components should be conducted.

Primary Dysmenorrhea in Relation to Oxidative Stress and Antioxidant Status: A Systematic Review of Case-Control Studies.

Primary dysmenorrhea is defined as painful menstrual cramps of uterine origin in the absence of pelvic pathology and is the most common gynecological disorder among women of reproductive age. The aim of this study was to systematically review case-control studies that have investigated the oxidative stress, antioxidant status, and inflammation markers among women with primary dysmenorrhea and controls. The study protocol was registered with PROSPERO (no. CRD42020183104). By searching PubMed and Scopus databases as well as reference lists, six case-control studies with fifteen eligible markers (seven oxidative stress, seven antioxidant status, one inflammation) were included in this review. The quality of the included studies was assessed as medium or high. The systematic review included 175 women with primary dysmenorrhea and 161 controls. The results indicate an elevated level of oxidative stress, especially of lipid peroxidation among dysmenorrheal women. For the antioxidant status, limited evidence was found for a lower status among primary dysmenorrhea women, and only one study examined one inflammation marker (hs-CRP), which makes it impossible for such a conclusion. To establish whether oxidative stress, antioxidant status or inflammation participate in the pathophysiology of primary dysmenorrhea, high-quality studies with larger study groups and clear case definitions are needed.

Transcriptomic Profile of Genes Encoding Proteins Involved in Pathogenesis of Sjögren's Syndrome Related Xerostomia-Molecular and Clinical Trial.

Sjögren’s syndrome (SS) is characterized by xerostomia. We aimed to investigate and compare gene expressions in the labial salivary glands of SS patients with xerostomia SS (sicca) and without xerostomia SS (non-sicca) and of healthy subjects (HS) by means of microarray analysis, and to find genes involved in xerostomia. The study group comprised 11 SS patients (3 SS (sicca) and 8 SS (non-sicca)) and 9 HS. The relative gene expression changes were validated with RT-qPCR in the larger study group. Among the differently expressed genes belonging to the “secretion” ontology group with a fold change >2 and with a p value < 0.05, the Transmembrane P24 Trafficking Protein 10 (TMED10), Protein Disulfide Isomerase Family A Member 4 (PDIA4), Calnexin (CANX), Amyloid Beta Precursor Protein (APP), and Transmembrane BAX Inhibitor Motif Containing 6 (TMBIM6) gene expressions in both SS (sicca) and SS (non-sicca) groups were lower than in HS. Significant correlations were observed between TMED10, PDIA4, and CANX gene expression in SS (sicca) patients compared to the controls. There were no differences between the SS (sicca) and SS (non-sicca) study groups in the expression of the aforementioned genes. Results indicate their role in the endoplasmic reticulum system, their overlapping function and the loss of the APP neuroprotective function in xerostomia. It has a multifactorial origin and can be triggered by disturbances to the various signaling pathways in saliva secretion.

EQUSUM: Endometriosis QUality and grading instrument for SUrgical performance: proof of concept study for automatic digital registration and classification scoring for r-ASRM, EFI and Enzian.

STUDY QUESTIONIs electronic digital classification/staging of endometriosis by the EQUSUM application more accurate in calculating the scores/stages and is it easier to use compared to non-digital classification?SUMMARY ANSWERWe developed the first digital visual classification system in endometriosis (EQUSUM). This merges the three currently most frequently used separate endometriosis classification/scoring systems (i.e. revised American Society for Reproductive Medicine (rASRM), Enzian and Endometriosis Fertility Index (EFI)) to allow uniform and adequate classification and registration, which is easy to use. The EQUSUM showed significant improvement in correctly classifying/scoring endometriosis and is more user-friendly compared to non-digital classification.WHAT IS KNOWN ALREADYEndometriosis classification is complex and until better classification systems are developed and validated, ideally all women with endometriosis undergoing surgery should have a correct rASRM score and stage, while women with deep endometriosis (DE) should have an Enzian classification and if there is a fertility wish, the EFI score should be calculated.STUDY DESIGN, SIZE, DURATIONA prospective endometriosis classification proof of concept study under experts in deep endometriosis was conducted. A comparison was made between currently used non-digital classification formats for endometriosis versus a newly developed digital classification application (EQUSUM).PARTICIPANTS/MATERIALS, SETTING, METHODSA hypothetical operative endometriosis case was created and summarized in both non-digital and digital form. During European endometriosis expert meetings, 45 DE experts were randomly assigned to the classic group versus the digital group to provide a proper classification of this DE case. Each expert was asked to provide the rASRM score and stage, Enzian and EFI score. Twenty classic forms and 20 digital forms were analysed. Questions about the user-friendliness (system usability scale (SUS) and subjective mental effort questionnaire (SMEQ)) of both systems were collected.MAIN RESULTS AND THE ROLE OF CHANCEThe rASRM stage was scored completely correctly by 10% of the experts in the classic group compared to 75% in the EQUSUM group (P < 0. 01). The rASRM numerical score was calculated correctly by none of the experts in the classic group compared with 70% in the EQUSUM group (P < 0.01). The Enzian score was correct in 60% of the classic group compared to 90% in the EQUSUM group (P = 0.03). EFI scores were calculated correctly in 25% of the classic group versus 85% in the EQUSUM group (P < 0.01). Finally, the usability measured with the SUS was significantly better in the EQUSUM group compared to the classic group: 80.8 ± 11.4 and 61.3 ± 20.5 (P < 0.01). Also the mental effort measured with the SMEQ was significant lower in the EQUSUM group compared to the classic group: 52.1 ± 18.7 and 71.0 ± 29.1 (P = 0.04). Future research should further develop and confirm these initial findings by conducting similar studies with larger study groups, to limit the possible role of chance.LIMITATIONS, REASONS FOR CAUTIONThese first results are promising, however it is important to note that this is a preliminary result of experts in DE and needs further testing in daily practice with different types (complex and easy) of endometriosis cases and less experienced gynaecologists in endometriosis surgery.WIDER IMPLICATIONS OF THE FINDINGSThis is the first time that the rASRM, Enzian and EFI are combined in one web-based application to simplify correct and automatic endometriosis classification/scoring and surgical registration through infographics. Collection of standardized data with the EQUSUM could improve endometriosis reporting and increase the uniformity of scientific output. However, this requires a broad implementation.STUDY FUNDING/COMPETING INTEREST(S)To launch the EQUSUM application, a one-time financial support was provided by Medtronic to cover the implementation cost. No competing interests were declared.TRIAL REGISTRATION NUMBERN/A.

S3170 Evaluating and Improving Intravenous Line Functionality Prior to Endoscopic Procedures

INTRODUCTION: Endoscopists and anesthesia providers at our institution have expressed concern over the efficacy of intravenous lines in patients undergoing inpatient endoscopic procedures. The anesthesia provider or nursing staff often need to adjust or restart the IV to maintain adequate flow throughout the procedure. To date, there is a paucity of research investigating IV functionality for patients presenting to the endoscopy unit. This study aims to evaluate our institutions’ IV functionality and whether an IV checklist prior to presentation to the endoscopy unit can improve outcomes. METHODS: All inpatients at Riverside Medical Center, between January 2020 to March 2020, who underwent an endoscopic procedure were included in the study. A chart review of thirty-seven procedures was performed between January 6 through February 2, this represented the pre-intervention group. The anesthesia provider reported the IV site as maintained, adjusted, or restarted. Our intervention included a checklist and education provided to floor nurses in advance of patients scheduled for endoscopy. The checklist included three items; identify appropriate size and location (ideally twenty gauge or larger and not positioned in the antecubital fossa), verify function (flushes easily without repositioning), and secure position (tape or Tegaderm without leakage or bleeding). The same information collected was used in the post-intervention group with forty-two procedures included from February 3 to March 2. RESULTS: Groups were analyzed as functional, restarted, or adjusted. There were a total of thirty-seven patients in the pre-intervention group of which eleven failed (29.7%) to maintain a functional IV (four adjust and seven restart). Forty-two patients were included in the post-intervention group of which six failed (14.3% with one adjust and five restart). None of the results were statistically significant at the P level ≤ 0.05. CONCLUSION: There was a 15% reduction in the need to restart or adjust an IV after the intervention. Although this was not statistically significant these results may be clinically significant. In our institution, there was more understanding of the key factors needed to maintain an IV site. This was evident analytically by the reduction in the numbers of adjusted IV and increase in the number of functional IV, (12.2% vs 27.0%) and (70.3% vs 85.7%), respectively. Future studies could benefit from larger study groups. Our analysis could not be continued due to the COVID 19 crisis.