cohort, 87%, 80%, and 44% were referred to a cancer center, seen by an oncologist, and treated, respectively. Among referred patients, 73%, 24%, and 3% were from urban, rural, and unknown settings respectively. Median time from referral to consult was 11 days for both urban and rural populations (p¼0.05). Patients with fewer hospitalizations waited 9 days from referral to consult compared to 13 days for individuals with more hospitalizations (p<0.001). Rural patients were less likely to be referred (OR 0.442, 95% CI 0.269-0.725, p¼0.001) and treated (OR 0.643, 95% CI 0.426-0.971, p¼0.036) whereas hospitalized patients (OR 2.855, 95% CI 1.158-7.042, p¼0.023) and those with longer hospital stays (OR 2.728, 95% CI 1.603-4.644, p<0.001) were more likely to be referred. All patients experienced a poor prognosis, irrespective of urban vs. rural (HR 1.169, 95% CI 0.986-1.386, p¼0.072) and hospitalization (HR 0.993, 95% CI 0.824-1.198, p¼0.945) status.Conclusions: Rural patients with AGCs face potential access barriers due to geography. By the time that patients are hospitalized, referral and treatment still translated to poor survival. Prompt referral and entry into the cancer care system is essential, particularly for patients who live remotely.Legal entity responsible for the study: The authors.

Amaç: Metastatik mide kanseri sık görülen ve prognozu kötü olan bir hastalıktır. Bu yaygın hastalıkta prognozun basit bir tam kan sayımı ile tahmin edilmesi birçok çalışmada dikkatleri üzerine çekmiştir. Ancak çalışmaların sonuçları birbiriyle uyumlu değildir. Bu çalışmanın amacı, ilerlemiş mide kanserli (İMK) hastalarda tam kan sayımı parametreleri ile hastalık prognozu arasındaki ilişkiyi değerlendirmektir. Gereç ve Yöntemler: Hastaların İMK tanısı anında herhangi bir tedavi almadan önce kan sayımları incelendi. Tam kan sayımından elde edilen tüm parametreler kayıt edildi; Nötrofil lenfosit oranı (NLR), trombosit lenfosit oranı (PLR), monosit lenfosit oranı (MLR), sistemik immün-enflamasyon indeksi (SII). Hastalar medyan NLR, PLR, MLR ve SII değerlerine göre iki alt gruba ayrıldı. Bulgular: Çalışmaya İMK'li toplam 105 hasta dahil edildi. Düşük NLR grubundaki hastalarda medyan sağkalım 14,6 ay iken, yüksek NLR grubunda 7,9 aydı (p=0,008). Ortanca sağkalım düşük PLR grubunda 12.7 aya karşı yüksek PLR grubunda 8.2 aydı (p=0.019). Ortanca sağkalım süresi yüksek MLR grubunda 14.6 ay iken, düşük MLR grubunda 7.9 aydı (p=0.06). Sonuç: Tam kan sayımından elde edilen parametreler aracılığıyla NLR, İMK'li hastalarda umut verici bir prognostik belirteç gibi görünmektedir.

PurposeMetastatic gastric cancer is a common disease with poor prognosis. In this common disease, estimating the prognosis with a simple complete blood count has attracted the attention in many studies. However, the results of the studies are incompatible with each other. The aim of the study was to evaluate the relationship between parameters of the complete blood count and disease prognosis in patients with advanced gastric cancer(AGC).MethodsBetween 2009 and May 2019, the files of patients with AGC were retrospectively evaluated. Blood counts of the patients were examined before receiving any treatment at the time of diagnosis of AGC. All parameters derived from complete blood count and defined in literature were evaluated in this study. These were; Neutrophil lymphocyte ratio(NLR), platelet lymphocyte ratio(PLR), monocyte lymphocyte ratio(MLR), systemic immune-inflammation index(SII), hemoglobin, lymphocyte, platelet. The patients were divided in two subgroups according to the median values of NLR, PLR, MLR and SII.ResultsA total of 105 patients with AGC were included in the study. The median survival in the patients with low NLR group was 14.6 months compared with high NLR group was 7.9 months (p=0.008). In low PLR and MLR group the median survivals were 12.7 and 14.6 months compared with high PLR and MLR were 8.2 and 7.9 months respectively (p=0.019, p=0.06). There was no significant relationship with SII (p=0.375). Multivariate analysis showed that NLR was an independent predictor of overall survival.ConclusionThrough the parameters derived from complete blood count, NLR appears to be a promising prognostic marker in patients with AGC.

BackgroundFamilial Mediterranean Fever (FMF) is the most common form of autoinflammatory diseases that is characterized by febrile episodes of serositis, arthritis and skin rash (1). Mutations in MEFV gene causes dysfunction of pyrin inflammasome, ultimately resulting in over-activation of Caspase-1 which is responsible for catalytic activation of interleukin (IL)-1 beta and gasdermin-D (2). IL-37 is also one of the IL-1 cytokines activated by caspase-1 acting as natural inhibitor of inflammation (3).ObjectivesIL-37 has pathogenetic roles for certain inflammatory diseases. We aimed to investigate serum IL-37 levels and its relationship with clinical and laboratory features of disease.Methods58 adult patients diagnosed with FMF according to Tel Hashomer criteria were included. Thirty subjects were served as healthy control subjects. Demographic, genetic, clinical and laboratory features and treatment responses of patients were recorded. Twenty-nine patients were colchicine responsive whereas 29 were colchicine refractory. Serum IL-37 levels were measured by ELISA from blood samples obtained at attack free periods.ResultsPeritonitis was the most common attack type (81%) followed by fever (80%) and arthritis (67%). There was no difference between FMF patients and healthy subjects for their serum IL-37 levels. A negative correlation was found between IL-37 values ​​and erythrocyte sedimentation rate in FMF patients (r: -0,31; p:0.015). IL -37 level was found to be significantly lower in patients who suffer from arthritis (median [IQR] 119 [396] ng/L vs 53 [164] ng/L, p= 0.03), myalgia (147 [364] ng/L vs 53 [84] ng/L, p= 0.05) or skin rash (102 [360] ng/L vs 54 [130] ng/L, p= 0.05) compared to those who did not have these attacks.ConclusionAlthough there was no difference in serum IL-37 levels between FMF patients and healthy subjects, IL-37 seem to be associated with musculoskeletal and skin attacks of FMF. Further research is needed to determine whether IL-37 have relationships with other features of FMF such as spondyloarthritis and febril myalgia.References[1]El-Shanti H, Majeed HA, El-Khateeb M. Familial mediterranean fever in Arabs.Lancet. 2006;367(9515):1016–24.[2]Kanneganti A, Malireddi RKS, Saavedra PHV, Vande Walle L, Van Gorp H, Kambara H, Tillman H, Vogel P, Luo HR, Xavier RJ, Chi H, Lamkanfi M. GSDMD is critical for autoinflammatory pathology in a mouse model of Familial Mediterranean Fever. J Exp Med. 2018 Jun 4;215(6):1519-1529. doi: 10.1084/jem.20172060[3]Nieman DC, Ferrara F, Pecorelli A, Woodby B, Hoyle AT, Simonson A, Valacchi G. Postexercise Inflammasome Activation and IL-1β Production Mitigated by Flavonoid Supplementation in Cyclists. Int J Sport Nutr Exerc Metab. 2020 Sep 15:1-9. doi: 10.1123/ijsnem.2020-0084.AcknowledgementsNo financial support is obtained from any companyDisclosure of InterestsNone declared