Selda Hakbilen

Lymphoma is a type of cancer classified under blood cancer, emerging because of cell degradation. It is visualized using computed tomography (CT) and positron emission tomography (PET). Segmentation refers to the process of separating the desired object from the background and other elements in an image. In this study, CT images obtained from lymphoma patients were segmented using U-Net, a deep learning-based segmentation model. The test results achieved were a 0.83 Dice Similarity Coefficient (DSC), 0.73 Jaccard Index (JI), an average Hausdorff Distance (HD) of 15.81 mm for neck axial CT images, and a 0.75 DSC, 0.64 JI, and an average HD of 30.18 mm for neck coronal CT images. The detailed statistical and visual analyses demonstrated that the lymphoma lesion segmentation was successfully performed on neck coronal and axial CT images using U-Net.

Objectives: Systemic sclerosis (SSc) is a chronic autoimmune disorder characterized by progressive fibrosis, vasculopathy, and immune dysregulation, leading to multi-organ involvement. Cardiopulmonary complications are major determinants of morbidity and mortality in SSc. Epicardial adipose tissue (EAT), a metabolically active adipose tissue, has been implicated in systemic inflammation and cardiovascular risk. However, its role in SSc remains poorly understood. This study aims to evaluate the relationship between EAT and SSc patients. Methods: This retrospective cross-sectional study was performed at Rheumatology department between 2020 and 2021. Patients were classified according to the 2013 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) criteria for SSc. Laboratory and radiology results were obtained from the electronic registration database. Data were analyzed and compared between groups. EAT was measured using non-contrast computed tomography (CT), and its correlations with clinical features, inflammatory markers, and thoracic CT abnormalities were evaluated. Results: A total of 229 participants, 157 with SSc and 72 age-matched healthy controls, were included in the study. The mean EAT volume was 171.02±81.84 cm³. Correlation analysis revealed a significant positive correlation between EAT volume and interstitial lung disease (ILD) (r=0.260, P=0.001), C-reactive protein (CRP) levels (r= 0.250, P=0.002), disease duration (r=0.205, P=0.010), and age (r=0.528, P<0.001). ROC analysis showed a moderate discriminatory power of EAT volume with an area under the curve (AUC) of 0.647 (95% CI: 0.564-0.729, P<0.001). Conclusions: Higher EAT volume was observed in SSc patients with ILD, suggesting a possible role of epicardial fat in pulmonary involvement in SSc.

Introduction Sjögren’s syndrome (SS) is a chronic, systemic, and autoimmune disease characterized by lymphocytic infiltration of all exocrine glands, primarily the lacrimal and salivary glands. Chemokines play a key role in many inflammatory diseases. They play a fundamental role in recruitment, transport, and activation of immune cells. This study aimed to investigate the role of CXCL9, CXCL10, and CXCL13 chemokines in primary SS patients. Method The study included 62 SS patients and 68 individuals without known systemic or rheumatological disease. CXCL9, CXCL10, and CXCL13 levels were analyzed in both groups using ELISA test kits and compared. The mean age of SS and healthy controls (HC) were similar. White blood cell neutrophil and lymphocyte values were found significantly lower in the SS compared to the HC; ESR value was higher in SS. Other hemogram parameters such as hemoglobin, platelets, monocytes, and CRP did not show a significant difference. CXCL10 levels were found to be significantly higher in SS compared to HC. CXCL13 level was significantly lower in SS. However, there was no statistically significant difference in CXCL9 serum between SS and HC. There was a negative correlation between serum CXCL9 level and lymphocyte and there was also a positive correlation between CXCL13 serum level and leukocyte. Conclusion CXCL10 chemokine may serve as a potential biomarker for primary SS and it may also be a new therapeutic target. Key Points • Chemokines play a key role in Sjögren’s syndrome. • CXCL10 may serve as a potential biomarker for primary SS.

Background: Methotrexate (MTX) and leflunomide (LEF) play fundamental roles in rheumatoid arthritis (RA) treatment and require proper monitoring of side effects. Concerns about MTX/LEF‐related liver fibrosis (LF) in patients with RA remain unclear. This study investigated liver stiffness using two‐dimensional shear wave elastography (2D‐SWE) in RA patients undergoing disease‐modifying antirheumatic drug (DMARD) therapy. Moreover, 2D‐SWE was employed to evaluate the correlations between liver stiffness, cumulative MTX and LEF doses and risk factors for substantial LF. Methods: We recruited 222 participants from the Department of Rheumatology. The participants were divided into healthy controls ( n = 78) and patients with RA ( n = 144). Pearson's correlation analysis was performed to assess the correlations between liver stiffness and the cumulative dose of MTX/LEF and other clinical and laboratory variables. Results: The mean elasticity modulus was 4.79 ± 0.92 kPa, excluding the presence of significant fibrosis. Mean 2D‐SWE values were significantly lower in healthy controls than in RA treated with MTX and LEF. The cut‐off ≥3.8 kPa 2D‐SWE values with the sensitivity of 86.1%, specifity of 83.3%. 2D‐SWE values were not significantly different across the strata of the cumulative MTX subgroups. Conclusions: MTX and LEF increase liver stiffness but may be considered low risk for the development of LF.

Background: Ankylosing spondylitis (AS) is a chronic inflammatory disease which influences the proportion of immune cells. Tumor necrosis factor alpha (TNF-α) is essential in the pathogenesis of AS, and TNF inhibitors are the most effective treatment for AS patients. In recent years, routine blood parameters were reported as markers of systemic inflammation associated with the diagnosis and prognosis of numerous malignancies and chronic inflammatory diseases. This study aimed to investigate the relationship between haematological parameters and clinical parameters, disease severity and treatment response in AS patients treated with TNF inhibitors. Methods: A total of 326 participants were recruited from the rheumatology department in this study. Participants were divided into healthy controls (n = 178) and AS (n = 148). Neutrophil, lymphocyte, monocyte and platelet counts, neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR), platelet-lymphocyte ratio (PLR), platelet crit (PCT), mean platelet volume (MPV), red cell distribution width (RDW), systemic inflammatory index (SII), systemic inflammatory response index (SIRI), cluster systemic inflammation index (AISI) and RPR levels were analyzed for each participant. They were compared between healthy control, AS patients during the pre-treatment phase and three months after the treatment. Results: RDW, PLR, NLR, MLR, SIRI, AISI and SII were higher than healthy controls and decreased with treatment except SIRI. The decrease in AISI and SII after treatment was significant in HLA-B27 positive patients. MPV was lower than healthy controls and increased with treatment. SII, SIRI and AISI were significantly higher in the active AS patients than in the inactive patient. Also, they were correlated with erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Conclusion: SII, AISI, and SIRI may be valuable markers for demonstrating disease activation and evaluating the effectiveness of anti‐TNF‐α therapy.

Aim:Systemic lupus erythematosus (SLE) is a chronic autoimmune rheumatic disease with high cardiovascular mortality. Epicardial adipose tissue (EAD) is the visceral fat located between the myocardium and pericardium. EAD is recognized as an active metabolic and inflammatory tissue capable of producing and releasing various preatherosclerotic and proinflammatory hormones, cytokines. EAD is associated with coronary artery disease, metabolic syndrome, and subclinical atherosclerosis. In this study, we investigated the relationship between EAD and SLE patients. Material and Methods:A total of 73 patients were recruited from the rheumatology department of a single center as a case-control study. The participants were divided into two groups: 73 patients with SLE (group 1) and 60 age- and sex- matched controls (group 2). Laboratory and radiological results were obtained from the electronic registration database. Data were analyzed and compared between the groups. Results:There was no significant difference between the groups in terms of age, gender, height, weight, or body mass index (BMI). EAD was found to be significantly higher in SLE patients than in the control group. In the SLE group, EAD was found to be significantly higher in patients with low complement levels than in those without. There was a positive correlation between EAD and age, leukocytes, neutrophils, C-reactive protein (CRP), and BMI, but a negative correlation was found between SLE disease activity index. Conclusion:Increased EAD was found in SLE patients compared with the control group. In addition, a correlation was found between increased EAD and low complement and CRP. EAD may be a measurable and modifiable potential therapeutic target associated with inflammation and cardiovascular risk in patients with SLE.

Purpose: To investigate the diagnostic performance of gray‐scale ultrasound (US) and shear wave elastography (SWE) for determining salivary gland involvement primary Sjögren's syndrome (pSS).Methods: In this prospective study, the salivary glands of 72 healthy volunteers and 74 participants with pSS were examined by two blinded radiologists with consensus using gray‐scale US and SWE. SWE parameters were compared between groups. The area under the curve (AUC), sensitivity, and specificity of gray‐scale US and SWE was analyzed. The correlation between SWE and clinical findings was investigated.Result: The SWE parameters of the parotid and submandibular glands were significantly higher in the pSS group, but did not differ significantly based on serologic assays, Schirmer test, minor salivary gland biopsy, and comorbidities. The AUC values for gray‐scale US of the salivary glands were significantly lower than the AUC values for SWE. The elasticity modulus (kPa) of parotid gland had the highest AUC value (0.937; 95% CI, 0.901–0.973), with a sensitivity of 93.2% and a specificity of 83.3%. SWE had no correlation with age, disease duration, laboratory values, or disease activity.Conclusion: SWE provides excellent diagnostic performance for submandibular and parotid gland involvement in pSS and can be used to complement gray‐scale US.

Aim: Systemic sclerosis (SSc) is an autoimmune disease characterized by generalized micro and macroangiopathy. Mortality in SSc is primarily due to pulmonary complications. This study was aimed to reveal the relationship between parenchymal and vascular involvements of the pulmonary system and hematological parameters in patients with SSc. Material and Method: Participants were divided into three groups: both interstitial lung disease (ILD) and pulmonary hypertension (PH), those with only ILD and those with neither ILD nor PH. Laboratory data were compared between these groups. Results: ILD was found to be associated with high red cell distribution width (RDW) and erythrocyte sedimentation rate, independent of PH. The platelet (PLT) count was significantly lower, and the RDW to PLT ratio (RPR) level was significantly higher in those with ILD and PH coexistence compared to those with only ILD. Conclusion: RPR can be used as screening parameters for PH in ILD associated with SSc.

Background Familial Mediterranean fever (FMF) is the most common autoinflammatory disease characterized by short, repeated, and self-limiting attacks of fever and serositis. Subclinical inflammation can persist in the periods with no symptoms and result in amyloidosis even with colchicine treatment. Neopterin and calprotectin have been considered essential players in inflammation and immune response. Aim The study was aimed to measure serum levels of neopterin and calprotectin in patients with FMF in the attack-free period. Methods A total of 160 participants were recruited from the rheumatology department in this single-center, case–control study. Individuals having the inclusion criteria were divided into healthy controls (n = 80) and FMF (n = 80). The laboratory data were acquired from the electronic registration database. Serum calprotectin and neopterin were measured with ELISA test kits. FMF patients and healthy controls’ laboratory findings were compared. Results FMF patients’ serum red cell distribution width (RDW), calprotectin, and neopterin values were significantly higher compared to healthy controls. There were no statistically significant differences between calprotectin and neopterin regarding gender, family history, and colchicine response of the FMF patients. Conclusions Calprotectin, neopterin, and RDW can be valuable marker candidates to be used in the follow-up of subclinical inflammation in FMF patients.

Familial Mediterranean fever (FMF) is an autoinflammatory syndrome characterized by recurrent episodes of fever and aseptic polyserositis. Subclinical inflammation generates a hidden threat to the development of FMF complications such as amyloidosis in attack-free intervals. The kynurenine pathway (KP) has been considered an important player in inflammation and immune response. The study was aimed to measure serum levels of KP metabolites in patients with FMF in the attack-free period. A total of 161 participants were recruited from the rheumatology department in this single-centre, case–control study. Participants meeting the eligibility criteria were divided into healthy controls (n = 80) and FMF (n = 81). The laboratory data were obtained from the electronic registration database. Serum tryptophan (TRP), kynurenine (KYN), kynurenic acid (KYNA), 3-hydroxyanthranilic acid, 3-hydroxykynurenine (3HK), and quinolinic acid (QUIN) concentrations were measured with tandem mass spectrometry. Laboratory findings of FMF patients and healthy controls subjects were compared and evaluated. Serum TRP and KYNA levels were significantly decreased in both FMF groups compared to the control group, while the levels of KYN, QUIN, 3HK, the KYN/TRP ratio, and red cell distribution width were higher. TRP degradation by the KP is increased in patients with FMF. KP metabolites can be useful in demonstrating subclinical inflammation.